TH E f "

F

O ANA D A LAN O E T

A MONTHLY JO U R NAL

ED CAL AND SU RG CAL SC ENCE,

CR ITICISM AND NEWS .

V O L . X .

T O R O N T ODU DLEY BU R NS , PR INTER S , R ANKIN BLOC K , C OLBORNE STR EET.

LIST OF CONTR IBUTOR S TO VOL. X .

W illiam Sloan, M .D. , Blyth .

C harles Black , A.M.,M .D .

,Forest

,Ont .

J . Gardner, M .D .,Hespeler.

J .Fulton ,M .D .

, Toronto .

A. McK innon,M .D .

,Lucknow.

A . H. Chandler, M .D .,Dorchester

,N . B .

G . B . Mott,M .D .

,Petrol ia.

J . R . Alexander,M .D .

,Montreal .

A. Alt.,

Toronto .

D . Clark,M .D .

,Toronto .

w. A. Willoughby,M .D .

,Colborne .

G . M . Aylesworth,M .D .

,Coll ingwood.

H . VanBuren , M .D .,Chicago

,U . S .

W. H . Hingston,M .D .

, e tc. ,Montreal .

H . J . Saunders, M .D .,

Millpoin t .

J. Workman,M .D . ,

Toronto .

C . W. C overn ton,M .D . ,

Toronto .

D . L . Philip,M .D . ,

Brantford.

J . A. Grant, M .D ., Ed .

,O ttawa .

J . Newell , M .D .,Springfield.

s. Fitch,M .D . Ed .

,Hal ifax

,

‘N. s .

A. A . Andrews,M .D . ,

Montreal .

H . McC oll, M .D .,Lapeer

,Michigan

,U . S .

James C attermole , M .D .,

London .

W. N . Campbel l , New York.

A. Groves , M .D ., Fergu s.

James Hayes,M .D .

,Simcoe.

W. B . Towler,M .D .

, Wingham.

N . A . Powell,M .D .

,Edgar.

D . W. Lundy, M .D . , Albany, II].

J . W. R osebrugh , M .D .,Hamilton .

A . D . Millar,M .D .

,New Dundee.

H . M . McKay , M .D . ,Woodstock .

J . R . Hamilton,M .D .

,Stratford .

D . O’Brien

,M .D .

,R enfrew.

E. G. Kidd,M .D .

,Manotick .

J . M . Smith,M .D .

,Morpeth .

W. R ear, M .D . ,Bracebridge .

J . J . H il lary,M .D .

,Jamaica.

V . A. Brown,M .D . , London .

J . H . R yan, M .D .,Sussex

,N . B .

W. F. Savage , M .D . , Elora.

T. S . Barclay,M .D . , Detroit, Mich .

A. Be thune, M .D . ,Wingham

,Ont .

Burrows,M .D .

, Lindsay, Ont.W. Workman , M .D ., Toronto .

THE CANADA LAN ( JET.

ANADAA MONTHLY JOU RNAL OFHE ANCET,

DICAL AND SUR G ICAL SCIENCE .

minimal dummuutmtiuua.

THE NATUR E AND TR EATMENT OFDIPHTHER IA.

BY WM . SLOAN,M .D.,

BLYTH,ONT.

MR . PR ES IDENT —In the remarks I have to

on th is occasion I do not intend to enter

upon the et iology or pathology of the d isease, but

merely to make a few suggestions which have

occurred to me in observing this troublesome and

in some cases unmanageable affection.

Since our last discuss ion on th is subj ect, some

18 months s ince,I have taken notes ofmy cases

47 in numbe r, and have observed each cas e as

closely as poss ible. I t appears to me that d iph

theria is a local disease,primarily

,and by absorp

tion through the veins,and th e glands ofthe neck,

and through them poison ing the circulation,pro~

duces not the symptoms ofsepticaemia, but afever, running an uncertain course, and no t

'lim ited

l ike the exanth emata to any particular period. I

have frequently seen al l th e symptoms ofacutefever with membranous exudation on the fauces

,

subside in 24 to 48 hours , and the patien t enter on

conval escence, while we frequently find simila r

cases in wh ich , at the end of14 days , the exuda

tion is still reproduced,and the debil ity and pro

character. In ad

favor ofmention

view of the local origin ofthe affection , and hisillustrations are very striking and conclusive.

Ziemssen leans to the same view , and his theory

as to the mode in which the rn icrococci developed

in the fungus,enter the circulation between the

interstices ofth e epithel ial cells is highly ingen ious.R oberts, whil e holding to the view that the d isease

is constitutional , and the exudation merely a symptom ,

l ike th e ernp tion ofscarlatina , urges upon u sthe advan tage ofl im iting the spread ofthe exudat ion by caus tics

, &c. Quay . Ifi t be only asymptom

,wherein cons ists the philosophy oftrying

to l imit i t any more than the pursuance ofa s im ilar course in measles and smallpox ?

As to prognosis the larger the exten t ofth e exudation the more serious the symptoms. In 5

cases in which th efauces,vei l of palate and phar

yux were covered as far as could be seen , 4 proved

fatal . Trousseau’s remark that a tawny appear

ance ofthe membrane indicates a severe case,seems to be well founded , and I have also found

that the more adhesive the membrane the worse

to deal with . There are some cases wh ich adhere

l ike wax,in which i t is almost impossible to re

move i t withou t more violence than we would l iketo employ, I don

’t l ike these case s. R apid er .

largement ofthe gland s ofthe neck indicatesmalignancy. Ifthe cel lular tissue covering theglands become involved with in 36 hours of the ap

pearance ofthe fungus in the throat, the case isserious. I t indicat es that th e virus i s part icularly

active,or that the system is in a pecul iarly favor

able conditionfor it s multipl icat ion . There doe snot seem to be any real danger so long as th e

glandular engorgement is ofa moderate character,excepting the disease should affect the larynx,when serious croupal symptoms migh t supe rvene.

I lost one case , No . for want ofattending toa precaution

,which

,as I have not seen mcn

tioned by any author, I wil l mention here. J . O .,

female,aet. r 3, severe case, had fever, glandular en

gorg’

emen t, both sides, and pharynx coated with

deposi t when first seen,but under the influence of

remedies improvement took place, and in fou r

days the throat was clear and the patien t conva

lescent. In five days more the patien t was up and

seemed perfectly wel l,with one pecul iarity, tha t in

the recumben t position th e pulse was 90, whilewhen erect i t was 1 20 . Three days after, whenengaged in some domest ic labour, she fainted and

2 THE CANADA LANCET.

expired instantly. NO S . 2 5 and 36 were similarly DEATH FR OM OCCLUSION AND R U Paffected, but by insisting on rest in bed til l the

TUR E OF THE SU BC LAVIAN VEINsystem gained strength they both did well .

Tr eatmezzt. I cons ider local treatment as ofthe BY CHAR LES BLAC K

,B .A.

,M .D.

,UN IVERS I TY OF

fi rst importance. I prefer tmcturafem mur. pure, M ICH IG AN.

or variously d ilu ted with glycerine ; I t loosens the

membrane the best ofanything. I tried Kerr’s

and Mon sel’

s solutions, bu t they did not seem to

act so favourably . I tried the chlorine water on

four cases,in the mode directed in the CANADA

LANCET, but soon discontinued i t. Sal icyl ic acid

pure,or with an equal quantity oftannic acid, after

the membrane has been removed by the iron ,dries up the surface better than any other appl icat ion

,and the same m ixture is the best that can be

blown in the nostrils when the membrane extendsth ither. Three cases had discharge from the ante

rior nares,and all recovered. Salicyl ic acid gives

l ittl e or no pain, an important matter. I have

given up the appl ication ofmuriatic acid, becauseit is so painful . Alum and honey every second

hour,al ternating with t he sal icylic acid and the

iron three times a day,appear to satisfy me better

than any other applications. Gargles for those

old enough to use them ,ofchlorate ofpotassa,

sulphurous acid,t incture ofiron , and glycerine,

dilu ted,are excellen t ; and the same, with the ad

dition of quinine,in tonic doses in ternally every

four hours. All thefood we can introduce, andstimulants whenever debil ity becomes apparent,

w i l l not be disputed by any one. The mode ofmaking the appl ications is important. Instead ofthe swab in use years ago

,which choked the poor

children,and by which th e remedies were appl ied

indiscriminately to the heal thy and diseased sur

face,I now use a smal l brush with which th e solu ounces ofvenous blood.

t ions ‘ can be appl ied to the parts indicated, as wel l crease, and he was keptby lampl ight as during th e day, and ofwhich , after anodynes. On the a4th

on e or two appl ications , th e ch ildren have no was heard over the leftdread . They costfour cents each

,and I supply morning of the asth, patie

each patient with one. I bel ieve that many chil in bed,and expressed a

dren are lost for want ofth e remedies being pro U n iversi t H 11perly applied to the diseased surface.*

y a

O f the 4 7 cases , 43 recovered, four died ; oneofthose I have already referred to . The otherthree were in ear/r em ix when first seen ; all in as tate ofcomplete aphonia, proving that the disease had extended to the larynx. ti ll 1 0 o ’clock Monday a6th, when death put

A strip offat salt pork,four inches w ide, extend ing to end to his S Uflerings °

the ears on each s ide, brings out an eruption resembl ing At the post-mortem,madefour hours after de

croton o i l, and seems to reduce the swelling ofthe neck .I u se i t now in every case whenever swelling ofthe glands by PrOfessor MC I—Jean, assISted by the wn ter;appear.

_The notes ofthe following case possess manypoin ts ofinterest, and throw some l igh t on thoseobscure lesions that are frequently met in practice.

In the fall of ’76 Mr. J . F. Curry, ae t. 26, oftheSenior class in the Department of Me dicine and

Surgery in the Universi ty ofMichigan,received an

inj ury on the left shoulder,while engaged in a

game offoot-ball,fracturing

,as he thought, th e

second rib. No fracture was,however

,diagnosed .

He suffered severe pain for several days in theclavicular region

,and for some time after was un

able to use h is l eft arm with freedom . On th e1 2th of March while in the University hall h e had

a rigor and felt severe pain in the left shoulder.

The next day h e was seen by Dr. McLean ,

Professor ofSurgery, who , observing that theshoulder was swollen

,and that th ere was some

tenderness,though t he had a rheumatic attack,

and advised a bl ister and rest.For several daysthere was but l ittl e change

,til l the 1 8th when

symptoms of a very grave character manifested

themselves . Temperature 1 04° i

pain in the clavicular region,and along the

of the brachial pl exus. Countenance an

was ordered anodynes . Prof. McLean no

THE CANADA LANCET.

effusion ofblood in the axilla and mammary regionthe brach ial plexus ofnerves closely adhered to

n. All the

n the neighborhood infi l trated with blood

freshly formed adhesions between the pleura

costal is and pleura pulmonal is ofleft s ide deep

cervical lymphatic glands enlarged ; subclavian

vein bound down by inflammatory formation caus

ing obstruction and rupture ; large blood clot

under the biceps ; smal l amount ofpus in leftpleura ; sl igh t adhesions in left pleura due tosecondary inflammation no trace offracture inany ofthe ribs. The second rib had, however,been inj ured

,as the periosteum cou ld be readily

scraped offwith the handle ofth e scalpel. This

inj ury had caused deep seated inflammation wh ich

extended to all the tissues in the clavicular region ,and had occluded the subclavian vein, causing i ts

rupture . The case during its entire progress wasa very obscure on e

,and was only explained by the

post-mortem examination .

Mr. Curry was one ofthe most distingu ishedmembers ofth e medical class, and held th e

position ofhouse surgeon to the State Hospital.

I t was certainly sad that on th e very day ne

expected to rece ive h is degree, h is remains should

have been laid in the grave.

Glurrrapnmtmrr.

To the Ed i tor ofthe CANADA LANCE'I‘.S IR

,-At Vi ttoria, in th e Coun ty ofNorfolk,

Gates,whom detective

ummer. He had been

previously, but he stil l

th ing had occurred ; in

way to keep his name

He manifests nonymptom s ofbeing the “ Gates Aj ar,

” and if Mr.

ofh im he wil l have to do as Sam

he gates ofGaza. In a late number

ething about the goose that laid theen eggs

,and I have come to the conclusion

Vi t toria has Smith’s goose.”

Yours truly,

Ex CONCES SO .

Charlottevil le,Feb. 23, 187 7 .

s t i gmaguid es.

AMPUTATION THR OUG H THE KNEE

JOINT, WITH R EMAR KS.

*Disease ofthe Bones, page 33, et seq.

Case I . O . S ., aged fifteen years

,a well-develop

ed mulatto boy, in December, 18 73 , fel l wh ile getting from a wagon which was in motion

,and struck

the upper part ofhis left l eg against the iron ofthewheel . The blow was followed by an inflammationofan acute character which terminated in an abscessof the head ofthe tibia. This had opened externally.I firs t saw him i n June

, 1 8 74, when I found theupper end ofth e bone much enlarged . The legwas curved inward so much that when he stooderect the left foot crossed the righ t ankle, and didno t touch th e ground. There were Several open~ings on the anter ior upper hal f ofthe leg

,from

which pus flowed freely ; th e skin was thin andbrown in color, and the periosteum was separatedfrom the anterior upper half ofthe bone. A probepassed through the upper opening an inch and a halfi nto the bone, upwards and backwards towards thej oint

,which contain a moderate amoun t of fluid.

He does not remember when the abscess burs t,

but thinks it was some three or four months s ince.June 1 sth. His general condition was good

,but

the bone was so extensively d iseased that I thoughtit best to ampu tate the l imb through the knee-j o in twh ich I did by the circular method. The patellahad been displaced inward by the curving of th el imb

,and did not fi t well between th e c ondyles of

th e femur,so I removed it. He suffered but l i ttl e

consti tu tional disturbance after the operation.

Before it,his pulse was 7 8, and after it 90 and i t

fluctuated for several days between 90 and 1 00.

At no time after i t did the temperature ris e aboveThe stump healed readily th e ligatures

came away June 2 2d , and on the a8th he waswalking about on crutches .During the after-dressing of the stump care wastaken to draw the edges ofthe flap well backward ,so that when the wound healed the cicatrix wouldbe along the posterior border ofthe condyles ofthefemur

,where i t has remained to the present time.

Examination ofthe limb after removal showedthe periosteum to be extensively separated fromthe anterior surface ofthe bon e, which was muchroughened and bathed in pus. Upon section ofthe bone with a saw the abscess was found to bevery large i t extended upward n early to thearticular cartilage. The effusion into the j oint wasfound to be synovial in character. Without goingfarther into the details ofi ts pathological appearance

,I will state that i t appeared to me to bear a

close relation to, ifi t was not identical with , whatMarkoe describes as chronic s inuous abscess ofbone

.

” The disease was too far advanced tofol

£1 THE CANADAIANcn'r.

low the treatment advised by him , namely, thechisel ing out ofth e whole ofthe diseased bone. elbow -j oint.The bone after macerat ion was deposited in theArmy Medical Museum at Washington ; specimenNo. 66 59 Surgical Section .

Case I I . Fred Q., aged eleven years, while runn ing behind a wagon

,May 23 , 1 8 76, got h is righ t

l eg caugh t between the spokes ofth e wheel which wasrevolving rapidly, and received a compound comminuted fracture ofthe tibia and fibula

,with exten

sive laceration ofth e muscles. The periosteumwas s tripped cleanfrom the bones for about fiveinches. This was probably done by the twistingof the l eg in the rap idly revolving wheel .At three o ’clock P. M.

,about four hours after the

reception of the i njury,I saw him i n consul ta tion

with his attending phys ician,Dr. C . H . Masten . He

had i n agreatmeasure recovered from the shock oftheinjury, and was lying upon h is bed apparently nu

concerned about i t. There being no hope ofsaving the l eg, I amputated it through the knee-j oint,by the circular method

,making the incision in this

c rse about three inches below the lower border ofthe patella, which was not removed.

Everth ing did well after the Operation . He suffered l ittl e or n o constitutional irritation the stumphealed rapidly ; the ligatures came away in duetime, and in two weeks after he was Ont-doors oncrutches. In dressing the wound care was taken

,

as in the preceding case,to keep the l ine of cicatrix

well back from the face of the stump,where it has

since remained, so as to avo id pressure upon it,should he wear an artificial l imb.

R emarks : I t will be noticed that both subjectsofthis operation were boys

,and that one amputa

t ion was done for chron ic disease,the otherfor an

acute traumatic injury. Both “ere done by thecircular method. In on e case th e patella was removed in the other i t was left i n 5 1721. Little or

no consti tutional disturbance followed either operation , and th e stumps healed rapidly. They arebroad and firm , and afford an excellen t support foran artificial l imb, far superior to any th igh stumpor even to the knee after amputation ofthe l eg atthe point ofelection . I do not find that there i s anydifference i n the util ity of the stump

,whether the

patella be retained or removed. The danger tol ife is much less than amputation through thethigh and the liabil ity to osteomyelitis and pyaemia

,

with the consequent fatal ity,is a great deal less

than after amputation through the continu i ty ofthefemur, or through the tibia and fibula. In view ofthese facts , after considerable personal experiencein , and after extended observation of, amputationsthrough the continuity oflong bones

,I am led to

the conviction that —other th ings being equal— all

amputations in the continuity oflong bones l n thev ic i n i ty ofj oints should be avoided

,where it is

possible to d isarticulate from the‘ lower aspect ofthe articulation whether in the lower or upper

extremity,with one exception

,namely, that ofth e

This exception is apparent for veryobvious reasons.To the elaborate papers ofMarkoe, in the New

York M edzazl y oumzal for March 1 868, and ofBrinton

,in the Amer zam y oum al 0/ flze M edzcal

S u'

ances for April,1 868, th e reader is referred for

much valuable information concerning th is amputation . Their able discussion of this subj ect has leftbut l ittle to be sa id by subsequent wr i ters but thereports of additional cases will tend to confirm ormodify their conclusions.— D r . Mur szck, B oston

M edz'

ral y our flal.

‘LIG ATUR E OFTHE EXTER NAL ILIACFOR THE CUR E OF ANEUR ISM.

BY 0. PEMBERTON, ED. , BIRMINGHAM.

Mr.,agedforty-e ight, an act ive, well bu i lt,

w iry man,hav ing l ived all h is l ife i n a mounta inous

d istrict , ahd engaged enthus iast ically i n field sports ,especial l y hun ting, came to me on the 11th of January

,187 6, to ask my opin ion about h is left leg.

Uncovering the l imb, I saw at a glance that hehad an aneur i sm at the point of Scarpa’8 space, andwas th ink ing i n my own m ind how el igible i t 10and he looked for any form of treatment, whecal led my attent ion to the popl iteal Space, whfound a second

,but th is was not al l,for, n ow

rous to finger the course of the vessel above, Isoon arrested by a. th i rd underneath and some

i l iac,wh ich I

arrest the blounaffected bysounds naturalregard to size

,

as a ful l-sizedincreasing— as

noth ing was wrong w ith h im.

THE CANADA LANCET.

Operation— On Jan . 25 th

,in the presence of Mr.

Crompton,and assisted by Mr. Goodal l and Mr.

Bennet t May, ether being rendered completely effect ive by Mr. Lloyd Owen

,I exposed the upper part

of the external i l iac artery by a free incis ion runningcons iderably h igher than the one ord inari l y adoptedi n Abernethy

’

s method. I had l ittle d iffi cul ty bythis means in apply ing the l igature around the vessel as close to the b ifurcation as poss ible and as farfrom the sac

,the fusiform expans ion ofwh ich , not

w i thstand ing,was clearly in v iew . The l igature

employed was one ofcatgut,specially prepared for

the case by Prof. Lister. Admirably round, fi rm,

yet flex ible, i t seemed to be the perfect ion of a. mater ialfor the purpose moreover intended to be ah

sorbent, but, as the sequel w il l show , th is propertyi t d id not posses s. In thes e proceed ings, happ ily,there were no m ishaps. The peri toneum

,although

necessari ly handled in uneover ing the artery so h ighup, was not inj ured, and not a s ingle ves sel in thewound requ ired ty ing. As soon as both ends ofthel igature had been cut offclose, the edges of thewound were closed by s i l ver sutures, during wh ichan abundant carbol ic spray was showered on the

parts invol ved, and finally the whole were coveredin by the ord inary complete antiseptic’ dress ings. Inthe l imb , pulsat ion ceased i n al l the aneurisms at

the same moment of t ighten ing the l igature ; th iswas then careful ly wrapped in cot ton-wool from toesto groin, and elevated. Four hours afterwards hecompla ined ofsevere burn ing pain in the toes andfoot

,the temperature ofwh ich registe red only

and had a blanched appearance. In seven hours thepain was in tense

,part icularly around and above the

ankle also there were marked cap i l lary stas is andl iv id i ty about lower part ofleg and dorsum of foot.Pulse 106 , persp iring profusel y. Half a grain ofmorph ia inj ected.

Thefol low ing day the toes and an terior part ofthefeet were blanched and insens ible to touch ,wh i lst a circle of increased sens ibi l i ty ex isted aroundthe ankle.

From th is time I may narrow the account ofthegangrene. For about three weeks i t graduallyspread , b i t by hit, up the leg un ti l a l ine ofseparat ionseemed fa irly defined at the j unction ofthe m iddle

the l imb. Th is,however

,

and in the weeks fol low ing11 unti l at one t ime Ifeared

As to the treatment of the l imb dur ing th is threemonths of gradual decay

,al l my endeavours cen

tered themsel ves i n ma intain ing the gangrene dry ,and i f poss ible ant isept ic. For th is purpose , Prof.Lister sugges ted to me to enveIOpe the parts in carboli sed cotton wool

,prepared by d issol v ing carbol ic

ac id in sulphuric ether,and saturat ing the wool w i th

it. I d id th is,and succeeded for many weeks in

keep ing all sweet. At length the deeper and th icker parts in the cal f overcame my precaut ions. Theseset up profuse d ischarges

,wh ich

,added to those

from the granulating surfaces,became fe t id

,and im

perilled l ife by set t ing up hect ic and i rri tat ive feverof a septic type

,wh i lst the foo t and lower th i rd of

the leg were as completely m umm ified as i t was poss ible

,and were able to be left bare. I was forced

to dres s the upper parts w i th ant isept ic washes,and

cover ings as s iduously n ight and morn ing,and for

tunately by such means t ided over d ifficul t ies thath itherto have almost invar iably sealed the fate ofa pat ient under s imilar c ircumstances.The constitut ional d isturbances that were present

during th is three months had the ir origin in veryd is t inct sur

gical cond itions . At the onset and las t

ingfor a per iod offrom three to four weeks, was i n

ab i l ity to pass water. I regarded th is as belongingto m ixed causes— due, on the one hand

,to the in

terruption of so large an ex tent ofthe circulation bythe appl icat ion ofthe l igature, and , on the otherhand

,to progress ive gangrene

,both circumstances

Operat ing at the same moment oft ime w i th com

bined force to induce sudden and profound nervousshock. The wound, too, exerc ised an influence

,for

al though i t was thoroughly ant iseptic and closed at

the th i rd week— short of afew granulat ions at i tsouter ex trem i ty— i t then suddenly became oedematous

,wh i lst rap id swel l ing about the upper aneur is

mal sac,and ex tend ing below Poupart’s l igament

,ind icated the d iffus ion of m isch ief over a w ide space.For six or seven days I was in hes i tat ion as to thepropriety of an incis ion in to some part of th is—forI had l i ttle doubt but that I was encountering asuppuration ofthe sac

,so near to wh ich was placed

the l igature— when, fortunatel y, the pus broke alongthe inner end of the wound underneath the healedintegumen t

,and found i ts way i n a vas t quanti ty to

the granulat ions, yet keep ing open i ts other end.

Great rel ief fol lowed th is occurrence, wh ich was nuattended by any blood discolorat ion save that d ueto the d isturbed granulat ions. But i f th is allev iatedsome of the patien t’s d istress, more especial ly in re

gard to the m itigat ion of the morn ing persp irationand the loss of appet i te, the onward progress ofthegangrene speedly renewed the ir influences. It was

very painful to w itness the dai ly emaciat ion, theloath ing for food that was ev idently present , addedto wh ich therewas intolerable pain in thedy ing l imb,assuaged onl y at n igh tfal l by the subcutaneous useof morph ia.At last came the succour of amputation and as

6 THE”CANADA LANCET.

that proceeding was performed when al l gangrene surgical practice requires that th e patien ts sohad absolutely ceased , h is hopes and h is strength treated shal l be kept separate from those who arebegan to rev ive at the momen t

,and were never

arrested by any drawback to the date of h is leav ingfor home,on the 20th ofJun e— five months after

the operation ,— h is stump hav ing soundly healed ,and the aneurismal sacs at Scarpa’s point and in thepopl i teal space being reduced to s imple well-definedi ndurat ions in the course ofthe artery.

And n ow to the story ofthe l igature. I hadnaturallyfelt very anx ious that my pat ien t, should,ifpossible, en counter no r iskfrom an inadequatematerial being used to secure the vessel . and at

the same t ime I could not pas s by the importance,

when arterial d isease appeared so marked, of avoidi ng cutt ing through the coats by ulcerat ion, and es

cap ing suppurat ion . Cer tain ly I should not havedeemed i t r igh t to have suspended every hope ofrecovery on the hazards ofthe ord inary catgut

,foralthongh I had mysel f met w i th no disaster in thevarious instances in wh ich I had secured large vessels in their cont in u ity by such means, I remembered I had used i t on ly in cases where I had st il lleft me a retreat in case offai l ure. Here

,in a des

perate pos i t ion , I was clearly about to play w i th afinal stake. Under these circumstances I consul tedProfessor Li ster. After one or two t rial s he sentm e the l igature I used , an t icipating that wh il st i tw ould prove sufficiently enduring to secure the

effectual clos ing ofthe artery, i t would be no lesscapable ofcomplete removal by absorpt ion .

W i th th is,as I have already stated. I t ied the

vessel by the reef-not, cu tt ing offboth ends close.

I n ever expected to see any th ing ofi t again . Buti t was otherw ise. W hen the suppuration of thesac had ceased I st i l l found the wound at the outeren d keeping very sl igh tly open

,and on dressing i t

some eight weeks after the operat ion, to my greatas ton ishmen t saw ly ing on i ts surface the unal terednoose of the l igature.

Oncommun icat ing w i th Professor Lister on thesubject, and return ing h im for safe keeping, th ish i storical loop, he wri tes The catgu t you usedhad been prepared by a n ew method, wh ich I havebeen labouring to perfect, and wh ich I expect verysoon to publ ish but your case shows that i t is poss ible to have the catgut, as i t were, too well preparedso as to remain unabsorbed and also rigid, and inconsequen ce of the latter property l iable to make i ts

not,the authorities ofthe hospital have placed two

wards— onefor male and on e for female patientsat Mr. Lister’s disposal . Is is reported that Mr.P. Heron Watson is l ikely to become a cand idatefor the chair ofClinical Surgery in th e UniversityofEdinburgh

,vacated by Mr. Listen— M ed ical

News and Library .

C LINIC ON HEART DISEASE BY PR OF.

FLINT, SR .

M ITRAL D I SEAS E, W ITH DILATATION.

I have asked the house physician , Dr. Taylor, tosel ect for me a couple ofcases ofcardiac diseasewith en largm en t, and told him that I would preferone with mitral l esion and the other with aortic

,i f

possible. Here is th e first patient, a man ofaboutthirty years of age. I have never seen him before,and al l that I know about him is that he has sometrouble about the heart. Now, let u s see if by putting certain questions we can form any conj ectureas to the nature ofthe latter. And, firs t, as to itsetiology. How long as i t been since you had anattack ofacute rheumatism ? He repl ies that hehas never had rheumatism at all. I supposed thathe would probably have given a rheumatic h istory;for, as you are aware, the great maj ority ofcasesof organ ic disease ofthe heart arise from rheumaticendocard itis . Our next inquiry is in reference tothe first symptom noticed, and the patien t informsus that i t was shortness ofbreath , nearly a year ago.

I t has continued with more or less severity up tothe presen t time

,and is sometimes so urgent that

he is unable to lie down . In addition to the dyspnoea

,we find that he has had a cough , with expect

oration,and that he has had haemoptysis five times

since last January. (You will please rememberthat subacute bronch i t is frequ ently occurs in conn ection w ith valvular disease ofthe heart. ) Anothersymptom that has also been present is oedema ofth e feet. Now ,

do the features of the case wh ichhave just been mentioned po int to m itral or toaortic d isease Let us take a vote on i t. All thosewho think the former is indicated will please holdup their righ t hands . I t i s carried by a large ma

way out l ike w ire or glass,w i th or w i thout suppura jori ty .

” Yes,all those symptoms point towards

t ion .

”

Th is incident over,the wound finally closed

,so

fi rm ly indeed as to precl ude any idea ofthe probab il i ty of hern ia — The Lancet.

PR OFES S O R LISTER — The Council ofK ing’s a m i tral regurgi tan t murmur.

m itral lesions,and show a probable enlargemen t

ofth e righ t s ide ofth e heart, due to this cause.Hav ing thus attempted to form some idea ofthenature of the case beforehand , I apply the s tethoscope

,and find that there i s both a m itral d irect and

Mitral obstruction isCollege London

,in order to have the benefi t ofa lesion which would especially account for the

Mr. Lister’s teach ing, have created a second chairofcl inical surgery, which has been offered to himand he has accepted . As Mr. Lister’s antisept i c

SEBYPROF.LATATION.

thathehassome

THE C ANADA LANC ET.

as that. This ~feebl e aortic second sound showsthat the ventricle contracts on an insuffi cien t quantity ofblood . The area of percuss ion-dulness overthe heart i s three or four times as great as that inthe healthy individual ; and i t is safe to say thatthe d ilatation now exceeds the hypertrophy, thoughnot to a great exten t. You will notice the apexbeat at a considerably lower point than i t should be.This patient has improved considerably since h is

admission to the hospital . There is now no oedemaat all

,and no l ividity ofthe l ips , as I am told there

was formerly. There is no indication at presentfor digitalis, as the heart is act ing very well. Theobject oftreatment here may be briefly sta ted to

be to put and keep the patient in th e best generalcondition that the circumstances ofthe case wil l admit of. He should therefore have the best alimentation and in the largest quantities that he can

possibly digest. In my opinion, i t i s far better toput too much into the s tomach than too l it tlethough I am aware that such views would not meetwith universal acceptance. In ad dition to goodal imentation

,al l th e hygienic surroundings should

practiceavoid doing what there isdo that for which there

AORTI C VALVES .

case,the nature ofwhich

as the last was one ofinfer that this would beill

,i t would not be safe

tion ; and, accordingly,be last case , to find out

toms, before

TR EATMENT or LEPR OSY BY G U R

JON O IL.

origin. Now, what is palpitation especially char

acteristic of Aortic trouble, you say ; and you

are righ t. And now,having formed a conj ecture

as to the nature ofthe case from the h istory given,

le t u s proceed to find out by exploration what isthe exact characterofthe d ifficul ty. F irs t, you willnotice that the apex is away 05 to the left, and cons id erably lower down than i t ought to be. Inlistening here, I detect a sl igh t mitral murmur, andi t seems to be a direct one. Sometimes this occurs temporarily, where there is a regurgitant aorti cmurmur, as I find to be presen t in th is case . In

addition I am able to make out here the pre-diastolic murmur, which , as i t does not seem to haveany particular significance

,I may perhaps be per

m itted to urge my claim to have been the first ohserver to d iscover. You wil l find i t j ust after thefirs t sound ofthe heart

,and j ust before the second

sound. There is , as you are aware, no very longin terval between the two sounds ; bu t it is longenough to note d istinctly the murmur to which Ihave referred. There is no very great amoun t ofaortic regurgitation in th is case . The aortic secondsound is not very feeble but th e pulmonarysecond sound I find to be decidedly l oud .

The following Extract is from a Medico topographical R eport ou the Andaman Islands by S urgeon-Major Hodder, M. D. Army Med. Department — Whilst speaking ofthe diseases of convicts,I wish to mention two novel modes oftreatmen twh ich

,th rough the kindness of Dr. Dougall

,Mad ras

Medical Service , Senior Medical Officer, Port Blairand N icobars, I have been able to see, and , thoughnot connected with the European detachment

,I

think should not be omitted in a report ofthiskind. The first relates to the treatment ofleprosyby gurjon oil— the oleo res in obtained from thedzpterom rpuslew r

,which grows abundantly al l over

these islands and in Burmah . When Dr. Dougal lfirst vis ited the Leper Ward in March 1 8 73 , hefound 24 patients, many in a wretched state withulcers

,portions of toes gone, anaesthes ia, and all

symptoms of leprosy clearly defined . He was muchimpressed with their wretched state

,and

,after

th inking the matter over for a while, decided to usethe gurjon oil— r part to 1 0 ofcocoa-nut oil

,as an

external appl ication . This was begun on the e3 rdMay 1 8 73 on al l the lepers , their bodies being rubbed all over with the o il. In June

,the proportion s

were altered to r to 5 respectively, and shortlyafter the gurjon oil was ordered internally also , in6-drop doses, and gradually increased to 60 drops.In j uly, Dr. Dougall noticed that the lepers where .

8 THE C ANADA LANC E'I‘.

improving in appearance,and gaining flesh , and

the sores were beginning to heal . He then photographed them for future comparison . The fi rstnotable improvements were the heal ing ofulcersand gradual diminution ofthe anes thesia. Notsatisfied with th e way the gurjon and cocoa-nut oilsm ixed

,Dr. Dougall in trying various vehicl es

,hit

on l ime-water,and found that th is and the gurjon

o il, in the respective quan tit ies of 3 and r,and

v iolently agitated , formed a substance l ike softbutter, and th is h e named gurjon oil ointment

”

i t is smooth , and no pain follows its application tothe healthy skin ; at the same time, he made anemulsion of equal parts of the oi l and l ime-water

,

for internal u se, in half-ounce doses , morning andevening. The following is now the plan oftreatment adopted. The lepers turn out at dayligh t, goto a stream , thoroughly wash themselves, usingpowdered earth as a detergent ; they then returnto their ward, receive the ir dose of emulsion , andthen rub their w/zo/e body with the ointment thisprocess should continue two hours

,and th ey are

supervised during th is t ime no l imit is placed onthe quantity ofo intment. At 3 P. M .

,the dose is

repeated, and the rubbing process again gonethrough for two hours . Dr. Dougall attributesmuch good to the prolonged rubbing, not only onaccoun t of the physical exercise i t entails

,but the

mental occupation i t supplies. The emulsion actsas a laxative and diuretic. Twenty—four lepershave been treated

,and in every case decided

benefi t has resulted every ulcer has healed,and

anae sthesia is markedly removed,and tubercles

have softened and disappeared. Through th eabove treatment

,men who for years have only

dragged on a miserabl e existence,are now abl e

and will ing to work , and the healed sores Show notendency to reopen . No change whatever wasmade in their d iet

,which was and is bad.

The second mode oftreatment referred to is thatof u lcers by dry earth in a powdered state. Manyofthe convicts who work at the clearings are sosaturated with and weakened by malaria

,that the

sl ightest scratch inflames and sloughs,leaving a large

foul—smell ing brown unheal thy-looking ulcer. Dr.Dougall has treated such cases

,with the best resul t

,

by means ofdry earth . The ulcer is washed,and

then the powdered earth,to the depth ofabout an

inch is placed directly on i t and a l ittl e over th emargins mois t sheets ofpaper are placed over th is

,

and a bandage over all,and leftfor 24 hours the

earth is then washed off, by means ofa stream ofwater, and fresh earth appl ied . Some smarting results, as the earth seems to act as a stimulan t aswel l as a deodorant. Very soon the brown surfaced isappears

,and all smell is at once removed

,and

healthy granulations S pring up . As soon as th istakes place the ulcer is dressed with carbol ic acidlot ion

,and heals quickly. Dr. Dougall has treated

very large numbers in this manner,and is entirely

satisfied with i t. I might mention that whils t serving in the Wes t Indies in 1 868, I treated severallarge ulcers in the gro in

,th e resul t ofsyph il is in

soldiers ofa West Ind ia regiment,with dry earth ,

and considered that the ul cers rapidly cleansed nuder the treatment. I had no opportunity ofcarrying i t ou t excep t in a few cases.

PR OPHYLAC TIC TR EATMENT OF PLACENTA PR /EVIA.

BY T. G . THOMAS . M . D.

There is but on e method at present at the disposal ofth e obstetrician by wh ich the evils attendant u pon the three last months of . , u tero~

gesta

t ion , and upon labor thu s complicated, can beavoided . I t is the induction of premature del iveryafter the period ofviabil i ty of the child. By th isprocedure a rat ional

,and it appears to me a perfectly warrantable, means ofavoidance of a great

danger i s offered to u s one which presents in i tsel f no dangers comparabl e with those ofnon in terference

,and one which

,while i t removes the ab

solute hazards attendan t upon delay, rel ieves thatwearing anxiety which harasses patient

,friends

and physician.

Fortunately this cond 1ti on i s usually announcedduring the last month s of utero-gestation by premon i tory signs ofrel iable character, and thus wemay empty the uterus before th e vital forces ofbothmother and ch ild are exhausted by hemorrhages,the results ofrepeated detachments of the placenta.

My conviction is that,in every cas e ofundoubted

placenta praevia, in which the flow of blood threatens

,by its amount or frequent recurrence, th e loss

ofmother and ch ild, premature del ivery should beinduced. What obj ection can be urged against i t,other than that a ch ild ofless than n ine months ofintra-uterine l ife does not have as good a prospectofl ife as one which has arrived at ful l term Inthe case which we are considering, even this is i hval idated by the fact that an eight-months ’ child outofthe u terus

,and d epending upon pulmonary res

piration , has a decidedly brighter prospect for l ifethan one in that cavity depend ing for aeration ofits blood upon a crippled and bleeding placenta.

For the mosafety whichuterus Bymonth ofwomanorrhages

moment

THE CANADA LANCET.

Under these circumstances,in th e words of Angus

McDonald ,“ noth ing can be gained by delay, if

we are satisfied that th e bl eeding 18 really seri ous,and ifcontinued would l ead to gr eat risk to themother’s l ife and health .

With these considerations before me , and with acertain amount ofexperience to support th em , Ican no t resis t the conviction that, when premature

de l ivery becomes the recogniz ed and universal pract i ce for placenta praev i a, th e statis tics Of thepresent day wil l be replaced by o thers ofa farmore satisfactory kind.

Of eleven cases in wh ich he resorted to th eabove plan . we give the following as a typical oneCase I . Mrs W. ,

aged twenty-s i x, prim i para, ingood heal th

,was suddenly taken with hemorrhage

three months before full term . She sentfor me i ngreat has te

,but being occupied I was unable to go

to her,and She was seen for me by my friend, Dr.

R eynolds. He discovered that she had lost a fewounces Of blood

,but that th e flow had ceased.

Three days after wards she was again affected in thesame way

,the flow ceasing spontaneously. About

a week after th is she was taken during the nigh twith a flow

,which was so profuse as to resul t 1n

partial syncope when she endeavored to walk acrossthe room .

“

I saw h er early the next morning ; foundher flowing S l ,

igh tly and upon vaginal exam inationsucceeded in touching th e edge ofth e placen tathrough the 05

,wh ich was dilated to th e s i z e ofa

ten cent p iece. Later in the day Drs . Metcalfeand R eynolds saw her, and agreed with me in thepropriety Of premature delivery. I n accordancew i th th is determination

,at 7 P. M . I introduced in

to the cervix,with considerable difficul ty and by

the employment of some force , the smallest ofTarnes’s d ilators. Th is was followed in twentym inutes by the next larger dilator

,and in an hour

by the largest. Dilatat i on was rapidly accompl ish ed,but ins tead ofremov ing the largest bag, I left i t in thecen ix until ten 0

’clock that n ight. Expulsivepains coming on at that time I removed i t, whenthe head rapidly engaged

,and before morning

Mrs . W. was safely del ivered Of a l iving girl . Theplacenta fol lowed rapidly, and both mother andchild did well — Extr actfrom Amer . P racti tioner .

NEW R EMEDYFO R BURNS AND SC ALDS . Dr.G. F. Waters, ofBoston , recen tly tested before themeeting of the Massachusetts Dental society a newremedy for bu rns and scalds

,consisting ofth e ap

pl icat ion of bicarbonate Of soda , th e s impl e cooki ng soda used i n al l famil ies. The doctor dippeda sponge into boil ing hot water and squeez ed i tover his righ t wrist

,the water flowing almost com

pletely around the arm ,and nearly encircl ing i t

with a severe scald two inches in width . Not content wi th th is

,he dipped the Sponge

-a second time,

and pressed i t closely on the under side ofhis wristfor th irty seconds . He then appl ied bicarbonate2

ofsoda to the scalded surface, and laid over i t awet cloth , and the intense pain was ban ished as ifby magic. On the next day after th is severe test

,

the s cald,with th e except i on ofthe part pu rposely

made mos t severe, was practical ly healed, only asl igh t d iscoloration ofthe skin showing wliere th escalding water had flowed —th is, too, without asecond appl ication ofthe sod a. The flesh on theunder s ide ofthe wrist had been cooked down to-th e sweat-glands, and the. scald was one whichordinarily would have caused an open and painfulwound Oflong durat ion . The only treatmen t Ofthis, however, after the first appl ication of the soda,was to keep the part mois t w i th a wet cloth and nopain was experienced , and i t was but a few daysbefore th is severe wound was seen to be rapidlyheal ing.

M P reeeedi ngr Mea’

. S ociety Kings C a , N Y.

DR . SAYRE’S APPAR ATUSFOR EXTENS ION IN POTT’S DISEASE .

The proper plan ofapply ing the plaster ofParisj acket i s to take loosely woven cloth

,such as cross

barred musl in,mosqu i to nett ing , or cheese-bandage

cloth,and cu t i t into strips three or four inches in

w idth,accord ing to the s ize ofthe patient upon

whom i t i s to be used,and then fi l l i ts meshes com

p‘etely.

by draw ing the cloth through and at the

same t ime rubbing into themfreshly gO Tonnd plasterofParis

,such as has not been exposed to the ai r.

The strips are then rolled up into t ight rollers afterthe fash ion ofthe ord inary rol ler bandage

,and are

readyfor use at any t ime occas ion may requ ire.

They S hould be kept in an air-t igh t t in ves sel .When you w ish to apply a j acke t

,the patient is

to be suspended by m eans of an apparatus,prepared

for the purpose (see Fig. 1 and cons isting ofcurved i ron bar w i th hooks at e i ther end from wh ichpass straps that are at tached to pads that go th roughthe ax i l lae and also under the occiput and ch in

,and

are capable (ifbeing made shorter or longer according to the length ofthe pat ient ’s neck . The i ronbar is suspended from the cei l ing by means ofacompound pulley through wh ich gradual extens ioncan be made until the pat ien t is drawn up so thatthe feet sw ing clear from thefloor.Prev ious to the suspension

,however

,a th in flex i

ble leaden strip should be la id upon the sp inousprocessesfor the en tire length of the sp inal col umn

,

and bent in to all the s inuosi t ies,so that i t may take

a perfect outl ine ofthe deform i ty. Th is strip i sthen laid upon paper and i ts outl ine marked w i think

,and we have a perfect mathematical ou tl ine of

the i rregulari t ies along the spinal column . After thepatient has been suspended

,the same leaden strip

should again be appl ied along the sp inous processes,

as i n the first i nstance,and another pattern made

upon paper by the s ide of the fi rst.Now we have a means by wh ich comparison can

10

be made, and we are able to determ ine exactly whatchanges have taken place in the curve. The sh irt

,

wh ich should be woven or kn it w i thout seams,and

t igh t ly fi tt ing the body,is nex t pulled down and an

open ing made in front and rear through wh ich ar ibbon or p iece of bandage i s passed for the purposeofhold ing in place a handkerch ief placed in the per in eum

, and at the same t ime mak ing the sh irtfi tthe hips exactly for the t ighter the sh irt fi ts theless number ofwr inkles there w il l b e in i t. The

rol ler bandages, prev iously prepared , are now set onend in a vessel contain ing sufficient depth of waterto cover them ent irely, and, at first , bubbles ofgasw i l l escape th rough the water freel y. When thebubbles cease escape, the bandages readyfor

Fro. 1.

S uspen s ion Apparatus with plain arch . C h in-neck and

axi llary bands are attached to sam e parts ofthe arch.

use. Then tak ing a rol ler in the hand, and squeezi ng i t gently so as to remove al l surplus water, comm ence j ust around the smal lest part of the body ,going to the crest ofthe i l ium and a l i ttle below i t

,

and lay i t around the body smooth ly, but do notdraw upon i t al l ; s imply unrol l the bandage w i thon e hand wh i le the other fol lows and brings it intosmooth close contact w i th al l the irregulari t ies ofthe surface

,over the i l ium and d ipping into the

groin over the abdomen and d ipp ing into the groi nagain

,and so on

,from below upwards in a Spiral

d irection unt i l the entire trunk has been inclosedfrom the pelv is to the ax i l lae. After one or twoth icknesses of bandage have been laid around thebody in the manner described

,narrow strips of perforated tin are placed paral lel w i th each other upon

THE CANADA LANCE'I‘.

CASE OF PAR ACENTESIS PER ICAR DII.

R . M’A.,aged 23

,by occupat ion a farmer, of

sangu ine temperament, v igorous constitution , andnever hav ing suffered from any prev ious i l lness,was seized

,after a severe wett ing fol lowed by a

ch ill,w ith wandering pains about the left s ide of

h is chestfor a week previous to my first seeingh im011 the 1st April , 1874, when cal led to v is it him ,

he was complain ing of d ifficul ty ofbreath ing, w i thsharp pain below the left n ipple. H e had profusepersp irat ion , of a d isagreeable odour h is urine wasleaded w i th urates. He had urgent th irst decubi

tus by preference on back S l ight inabi l i ty to l ie onleft s ide pulse and temperature n early natural.Jointsfree from pa in. Phys ical exam inat ion of theches t revealed dis t inct frict ion sound ofa to-and-frocharacter over the praecordial reg ion, and there was

e i ther S ide of the spine from two or three inchesapart

,and in numbers sufficient to surround the

body,and another plaster rol ler carried around the

body,covering them

,in the manner in wh ich the

first bandage was appl ied.

Thefew strips strengthen the bandage, and obvi

ate the necess i ty of increas ing i ts weight by the appl icat ion of a larger amount ofplaster. Ifthere areany very prom inent Sp inous processes, wh ich at thesame t ime may have become inflamed in con se

quence of pressure produced by instruments previously worn

,or from ly ing in bed , i t i s wel l to guard

such places by means ofl i ttle pads of cotton or clothor li ttle glove fingers fil led w i th wool wh ich is elast ic

,wh ich are to be placed upon either s ide of them

before apply ing the bandage.

Another suggest ion ,wh ich I havefound to be of

practical value, is to take two or three th icknessesofrol ler bandage three orfour i nches long, and

place them over the anterior superior Sp inous process of each i l ium . These l it tle pads are to beremoved j ust before the plas ter has completely set,

consequently leave the bony partfreefrom pressureafter the soft parts have shrunken under the i nfluence of the cont inued pressure produced by theplaster dressing. It is also wel l , j ust before the

plaster has set completely , to place on e hand infront of the i l ium and the other over the buttocks,and squeez e the cast together so as to increase th i sSpace over the bony prom inences. In a very shorttime the plaster becomes set suffi cient so that thepat ient can be removed from the suspend ing apparatus and laid upon the face or back on an air-bed ,where they are to remain unt il the harden ing proceSs is complete. A hair mattres s answers a verygood purpose, but the air-bed is preferable , especi

al ly ifthere i s much project ion of the Sp inous processes or the sternum.

THE CANADA LANCET.

dulness on percussion extend ing sl ightly beyond thenatural area. He was ordered to have hal f-a-dozenl eeches appl ied to the seat ofpain , and fi fteengrain s ofeach Ofthe b icarbonate and ace tate ofpotassa

, largel y d il uted , every two hours, and acalomel and op ium p i l l eveiy eight hours.52m! Apai l — Pa in and difficul ty of breath ing

greatly rel ieved,dul lness on percussion and frict ion

sound somewhat less. To have canthar ides bl ister,

4 x 4,appl ied to neighbourhood of heart.

3 rd Ap ri l. —Pa in and d ifficulty ofbreath inggone friction sound scarcely audible dul lness onpercuss ion confined to natural area. From th is t imet il l the 28th Apri l patient cont inued to improvestead ily

,and noth ing abnormal could be heard over

the region ofthe heart.On the 29th Apri l he sat up in bed for the first

t ime S ince the commencement of h is i l lness, but heno sooner d id so than he was again seiz ed w i thsevere catch ing pain under h is left breast. H ispulse rose to 120

,the urine was again loaded w i th

urates, and he could not l ie on the left S ide. The

treatment wh ich was found so effectual i n the prev ions attack was again stead i l y fol lowed. Despi tethe most assiduous use ofthese means

,s igns of

dai l y increas ing pericard ial effusion became man ifes t. Fri ct ion sound

,wh ich was present for the

fi rstfew days of th is at tack , was no longer aud ible,and the dull ness gradually i ncreased t i l l i t reachedthe second r ib in the upward and the level of thed iaphragm in the downward d irect ion. Transvers ely i t extended from the righ t margin of thesternum to about two inches beyond the left n ippleoutwards. The sounds of the heart were obscureand d istant. Co incid ing w i th the effus ion into thepericardium

,pneumon ic consol idat ion of the left

lung set in,i nvolving fully more than the lower

half of i t— d ue,no doubt

,to the pressure caused by

the d istens ion of the pericard ium . A loud systol icmurmur could now be heard over the base oftheheart. The th ri l l and i ts accompany ing undulatorymot ion

,said to be common in cases of per icard ial

effusion,could not be clearly made out in th is case,

al though any sudden movement of the patient gaverise to someth ing l ike i t. The pulse ranged from120 to 130 per m inute, smal l and irregular, andthe resp irations from 29 to 35 and shallow .

As the treatment fai led to check the pericardialeffus ion

,and as i t became ev iden t the pat ient must

soon succumb to the dail y increas ing d istension ofthe pericard ium

,I determined on perform ing the

opera t ion of paracentesis pericard i i. A consul tationw i th Professor C ai rdrter was Obtained w i th th isobj ect in view. The operat ion was performed w i ththe medium-s ized needle ofa Dieulafoy ’s rspi rator,and the place selectedfor i ts i ntroduction i nto thepericard ium was the fifth intercostal Space abouttwo i nches from the left margi n ofthe sternum .

Twenty ounces of a sl ightl y blood-t inged serous “ S ee Fuller on D i ser se S '

ofthe Heart and Hearflu id were drawnoff. The Operation was fol lowed Vessels, p. 73.

by the most marked rel ief to all the d istrcs ingsymptoms. The pulse

,wh ich before was weak and

i rregular,became stronger and regular

, and also lessfrequent. The breath ing assumed i ts naturalfrequency , and the physical signs ind icat ive of per icard ial effus ion d isappeared. The l ung

,wh ich was

in a state of consol idat ion to very nearly i ts wholeextent prev iously, gave forth i ts natural resp iratorymurmur immed iately after the operat ion was com »

pleted . Temporary rel ief, however was al l thatwas gained by the operation , for i n afew days S ignsofeffus ion into the pericard ial sac returned. Em

barrassmen t to the heart’s act ion and breath inggradual ly took place

,and the operat ion had to be

repeated on the 14th May . Again the most markedrel ief fol lowed the draw ing offof th i rty ounces ofserousflu id more deeply tinged w ith blood than on

the prev ious occas ion .

Complete freedom to the heart’s act ion again cont inned for afew days

,when the s igns ofreturning

Oppression to the circulat ion and resp irat ion S lowlyset in . On the 25 th May the asp irator had aga into be resorted tofor rel ief, when about fi fteenounces of a st il l more bloody-look ing serous flu idwere drawn off. The rel ief obtained th is t ime wasas great as after theformer operat ions, but less endur ing in i ts resul ts. The lung

,wh ich had recover

ed so comple tely i ts natural condit ion after the fi rstOperat ion

,became again consol idated before the

th ird operat ion was performed,and remained so

,

w i th the add i t ional compl icat ion ofeffusion into thepleural cav ity . The heart’s action soon becamefeeble and i rregular, w ithout s igns of effus ion

,in

any great quant i ty,i nto the pericard ium and after

cont inu ing for two days in a state oflow mutteringdel irium the pat ient quietly d ied on the 28th ofMay .

R emarks . The obj ect ofpubl ish ing th is casewhich I bel ieve to be of rare occurrence

,j udging

from thefew cases recorded of late years— is toshow the marked and unmistakeable rel ief thatfol lows the operation oftapping the pericard ium

,

where peri card itis, whether rheumat ic or non-rheumat ic

,term inates in some effus ion . No doubt the

success attend ing th is operat ion has h i therto beenbut small

,but that can hardly be advanced as a

sufficien t reason for i ts nonperformance when re

qu ired. The formation of an accurate d iagnosis isessential to i ts success in the fi rst instance

, whetheri t may be successful ul timately or not. This i s notso d ifficult as m ight at fi rst sigh t appear

, i n casesl ikely to requi re interference of th is k ind

, when wekeep

’

in remembrance that dulness ofa pyram idal form occurring suddenly i n a prev iousl yheal thy person is symptomat ic ofpericard ialeffus ion , and affords a tolerably accurate measureof i ts amount.”

12 THE CANADA LANCET.

We yet await the d iscovery ofa certainremedy whereby the re-accumulat ion ofeffus ion intothe pericard ium can be preven ted. In our searchfor such means we must look to the earl ier w ri terson th is d isease rather than to those who havew ri tten on the subj ect in more recent t imes. The

on l y”

author who has ven tured on actually carry ingth is intent ion into pract ice

,sofar as I can discover

,

i s Dr. Aran .

* In th is interest ing case, Aran tappedthe pericardium tw ice

,each t ime inj ect ing i nto i t

an i od inous solut ion,composed the first t ime of

t inct. of i odine to the same quant ity ofdist il ledwater

,w i th the addi t ion offour grammes ofthe

i od ide ofpotassium. The success ofthe operat ionwas complete

,the pat ient recover ing perfectly .

Dr. McLeod — G lasgow Med . Journal.

R ESTR ICTION AND PR EVENTION OFSCAR LET FEVER .

[EX'

JR ACTS FROM DOC UMENT IS SUED BY M IC HIGANSTATE BOARD OFHEALTH .]

Whenever a child has sore throat and fever, andespecial ly when this i s accompanied by a rash on

the body, the child S hould be immediately isolated as completely as possib le from other membersOf the household, and from other persons, until aphysician has seen i t and determ ined whether i thas scarlet fever. All persons known to be sickwith this disease Should be promptly and thoroughly isolated from the public.The room into wh ich on e S ick with th is disease

is placed should previously be cleared of al l needless cloth ing, carpets, drapery, and other materialsl ikely to harbour the poison Of the disease

,except

such articles as are essential to th e well-being ofthe patient . The S ick room may have no carpet

,

or only pieces which can afterwards be destroyed.

Provision Should be made for the introduction ofa l iberal supply of fresh air and the continualchange ofthe a ir ofthe room w ithout sensible currents Or drafts.Soiled bed and body l inen should be placed in

vessels Of water conta ining chlorinated soda,chlor

inated l ime, or other disinfectant before removalfrom the sick room . For this pu rpose chlorinatedsoda is the neatest, and most convenient becauseit can be used with soap, but i t is apt to lose i tsdisinfecting properties by age. Chlorinated l ime ifu sed too freely may destroy articles ofclothingw ith which i t comes in contact

,but if properly used

i t is the safest as a disinfectant. The dischargesfrom the patient should all be received into vesselscon taining chlorinated l ime (commonly calledchloride of sulphate ofiron

, or some otherknown disinfectant

,and the same buried at once

,

Bul letin de l ’Academ ie de Med icine,xxx i . , p . 142.

and not by any mean s be thrown into a runningstream

,nor into a cesspool

, or water-closet, exceptafter having been thoroughly d isinfected. All vessels should be kept scrupulously clean and disinfected . Perfect cleanliness ofnurses and attendantsshould be enj oined and secured. AS the hands ofnurses of necessity become frequently contaminatedby the poison ofth e disease

,a good supply of

towel s and two basins— one containing solutionofchlorinated soda (Labaracque’5 solution) chlorinated l ime or other dis infecting solution , and an

other for plain soap and water,Should be always

at hand and freely used. Funeral s ofthose dyingfrom scarl et fever should be strictly privateand the corpse not exposed to view. To avoidmistakes, n otices ofsuch deaths in the papersShould state that the deceased died of scarletfever.All persons recovering from scarlet fever should

be considered dangerous,and therefore should not

attend school,church

, or any other publ ic assembly, or use any public conveyance , so long as anyscal ing or peeling ofthe skin

,soreness ofthe eyes

or ai r passages,or symptoms ofd ropsy remain .

No person recovering from scarlet fever shouldthus endanger the publ ic heal th nor appear inpublic until after having taken four t imes

,at in ter

vals oftwo days,a thorough bath . This cleansing

,

however,should be deferred until th e physician in

charge considers it prudent. After recovery fromscarlet fever

,no person should appear in publ ic

wearing the same cloth ing worn wh ile S ick with or

recovering from this disease,except such cloth ing

has been thoroughly disinfected by some suchmethod as herein specified.

When a room and contents are to be disinfected ,all articles therein should be spread out so as to expose the greatest amount ofsurface to th e action ofth e disinfectant, and al l openings to the roomshould be closed. To generate Chlorine

,take per

oxide ofmanganese,place in an earthen dish and

add one pound of hydrochloric acid,to each four

ounces ofthe peroxide of manganese. Care Shouldbe taken not to inhale th e gas . After being certain that continuous evolution ofchlorine has beensecured

,l eave the room and close the door ofexit.

Thebleaching properties ofchlorine may destroythe color ofcolored goods exposed to it

,but as a

disinfectant it i s one ofthe bes t. To generate Sulphurous Acid gas, put l ive coals on top ofashes ina m etalic pan

,and place on th e coals sulphur in

powder or fragments. A convenien t way is toplace the coals and sulphur on a heated stove plateor cover turned bottom upward in a pan half fi lledwith ashes. To disinfect 1 00 cubic feet ofair requires the thorough combust ion ofabout one and

one-half ounces ofsulphur. R ooms Should be kep tclosed and subj ected to the action ofthe disinfecting gas for six or eigh t hours, and afterwardsthoroughly aired by Opening doors and windows .

THE CANADA LANCET.

Heat sufli cien t to be disinfectant for th is diseasemay be secured without destroying ordinary articl esofcloth ing, say at 240° to 250°FHYDR OTHOR AX, C LINIC BY PR OF.

FLINT, SR .

The next patien t is Mary Kessler,2 7 years old

admitted,Apri l 1 3 th . Her family history is unim

portant. Eigh t years ago she had typhoid fever,

and aside from this,she has always been perfectly

heal thy. Six months ago she commenced to havea cough without expectorat ion

,and severe attacks

ofcutting pains in both sides ofthe chest under th en ipples . These pains were increased on coughingor movemen t

,and at times were so severe that sh e

was obl iged to cry out. She had shortness of breathand dyspnoea. Physical examination revealed thefol lowing signs On palpation

,the precordial im

pulse was d iffused over an unnatural area, and theapex beats were in th e 6 th intercostal S pace in theax il lary l ine

,z j inches to left ofn ipple. Auscul

tation revealed a loud murmur,having i ts greatest

intensity at theapex , following the fi rs t sound, tran sm itted to the left

,and heard behind . On the righ t

side ofthe ches t the vocal fremitus was absent,and

on percussion there was found to be complete flatneS S below the third rib

,the level ofthe flat

ness being al tered on changing th e position ofth epatient. Below this l ine the respiratory and voicesounds were los t

,and above

,th e breath ing

broncho-vesicular in character. From these signswe would certainly conclude that there was effus ionin the righ t thoracic cavity

,but to confirm this con

elusion , the needle ofa hypordem ic syringe was i i itroduced , and some serous fluid withdrawn . Theabdomen was tender on pressure

,and on palpation

gave evidence of sligh t ascites . The l iver andspleen were S l ightly enlarged. The pulse was ao

celerated . Urine acid,Sp. gr. 10 1 2 , containing a

smal l quanti ty of albumen and afew small hyal ineand granular cas ts. She was placed on d igi tal is

,

and from th e date ofadmission has continued toimprove.We shal l not take up this case in al l i ts bearings

tod ay, but wil l leave the heart , and fix our attent ion for the present on the pleural cavity. Thequestion arises , is this a case ofhydrothorax or

pleurisy w ith effus ion . You perceive that there isa difference in the movements ofth e two S ides ofthe chest, th e righ t side scarcely moving at all.The l ine offlatness i s not far from the fourth rib ,so that we get d istinct signs ofconsiderable fluidstil l remain ing. She has an affection of the heartand some disease ofthe k idneys , and we wouldnaturally expect effusion to occur with les ions ofthese organs. The hands and feet are oedematous.We can settle th e question between hydrothoraxand pleurisy with effusion

,by examining the other

S ide of the chest ; if the latter be free from fluid,

we S hould say that the disease i s pleurisy,but i f

we‘

find fluid presen t on that s ide, we can consider i t to be due to hydrothorax. I t is scarcelynecessary to say that by the term hydrothorax wemean a serous transudation or a purely dropsical effusion in the pleural cavities.I t is a general law of pleurisy that the disease is

confined to one s ide of the ches t,whereas in by

d rothorax there is fluid on both s ides , although usually a greater amoun t on one side than on th eother. We examine now and find that there issome fluid present on th e l eft S ide. The presenceofserum on th is S ide is not absolute proof of thecase being one ofhydrothorax , but it adm its of th isexplanation , when taken in connection with theother facts ofth e case — Hosp i tal G az ette.

R EST AS A THER APEUTIC AGENT.

[The following is an extract from a lecture de

l ivered by Dr. S. W. Mitchell,before the Medical

and Chirurgical Society of Maryland, on the above

subj ect.]But if i t is easy to fatten and redden some

people,we know. also, that it i s hard to compass

this in others. In our great cities there exist ahost of influences for evi l which resul t in all classes ,and especially in women

,in the gradual creation

of patients who,having lost weigh t and become

anaemic find i t hard to rega in that competency ofcapital in fat and blood without which the businessofl ife is carried on at a dangerous cost. Wesearch in vain in these casesfor organic changeswhich may explain their condition . No funct ioni s wel l performed but it is u seless to correctd igestion or to treat an ulcerated womb , or ord erexercise. The blood is lacking to aid in the l ittl egains we win

,and exercise i s valuless or worse

when i t exhausts t issues which lack the means ofbeing rebuilded.

I need not dwel l on points so obviou s to educated physicians. For many years past I have hadmy though ts directed to th is subj ect, and l ikeevery one here, I have gone on month after monthtreating such cases with no better, and , I hope , noworse fortune than has fallen to others . A momentofhappy thought, and much reflection S ince, l edme to a method oftreating , which has rewardedme over and over with success so brill iant that, asthe plan ofcure involves the use of those extremem easures ofwhich I have been Speaking, I may bepardoned for call ing them to your atten tion .

“ And perhaps also the path by which I reachedmy conclusions may not lack i nterest.

Some years ago I saw a woman , who was l ikehalf a doz en any of you can now recall— a pall idfeeble creature

,who had menstruated irregularly

14 THE.CANADA LANCET.

until two years before, and then stopped at theage ‘

ofthirty. She was the type ofa class.Every th ing too wearied— to walk

,to read

,. to

drive, to sew. She was the woman with a back ,and a Shawl on her shoulders

,and a sofa for a

home, and hysterics for diversion . She had tiredout the doctors

,and exhausted drug-Shops and

travel, and outl ived a nurse or two. The deformity-man had found a Spinal curvature

,and pu t on a

brace; th e gynaecologist had had his turn; the quackshad had their share ; and she wore blue glassesto keep out the blessing of dayligh t. She was fivefeet four

,and weighed ninety-four pounds

,and had

as much figure as a hat-rack,and had no more

bosom than the average chicken of the boardinghouse tabl e. Nature had wisely prohibited th isbeing from increasing her breed . H ow many ofyou have stood helpless before this women Likeyou I had had my fa ilures with such cases

,and I was

driven to reflect as to what new device I could try.

Because everything tired her I put her at rest in bed.

I made res t despotic, absolute. Then I fed herwith milk at brief interval s. But

'

in afew days myplan failed. R est she took wel l enough , butattempts to feed resulted in S ick stomach anddiarrhoea, and new loathingfor food. Then I said,I must find some way to give exercise without exertion . I had seen in Europe how much use wasmade ofsystematic massage or kneading ofthemuscles . I knew that under i ts use the feebl el imbs of ataxics strengthen for a time

,so that

hopeful friends even dream ofa cure ; and I wasaware that it improved the local blood-circulationin a remarkable way, and gave to feeble and flabbytissues increase of tone and firm plumpness. I tseemed to me that i t could take the place of exercise for persons at rest.

“ I had also in electrici ty another means ofcausing muscles to contract withou t the action ofwil l or the exhaust ive use ofnerve-force.For the first time then

,I used on a woman at

rest, thorough massage and the abrupt muscle-stirring ofan inductive current.To my great pleasure

,I found in afew days

a return ofappetite. But is kneading of musclesa mere fetish also ? What scientific test have weofits activi ty? One, and a sure one , wh ich I havelately found. In weakly people

,despite the ex

posure to the air i t involves, this process ra ises thegeneral temperature to r%

° Fahr. And,as I

discovered th is w inter, to my surprise and pleasure

,an induction current

,either localiz ed or

merely allowed to pass to and fro,from neck to

feet,d oes precisely the same. They effect t issue

metamorphosis for the patient,in tissues l ittl e used

in bed.

I have employed every degree ofrest but i nth is woman ’s case

, as usually, I perm itted no exer

tion which could be avoid ed, and I carried it tosuch an extreme as to have ‘

the pat ient fed by

hand,because it is t iresome while recumbent to

use the arms,and because I have found that

human beings , l ike turkeys, can be made to eatmore when fed byanother agent.To this treatment in a few days may be added

raw soup and butter,and meat extracts, and iron

in large doses .I fed this women with growing surprise at her

power to digest as sh e reddened andfattened .

And how did she fatten and redden ? The nailsbecame pink ; the veins began to Show in thel imbs. At first

,as always

,the extremities became

cold under massage,then they grew warm

,and at

last, when sh e was well , th e massage no longerelevat ed her temperature. And th is is the rule.And as to fat

,i t comes firs t on the face and neck ,

and then on the back and belly, and last on thel imbs.

By absolute rest,massage

,and induction-cur

rents, you acquire power to over-feed, and the

tissues are enabled to reclothe them selves with fat ,and

,what is better

,you can thus refil l the blood

vessels. This woman came to me th in,sallow ,

ugly,and feeble. I sent her homefat and wel l ,

and vigorous and handsome,and menstruating

steadily ; and then nature relented and gave hera baby.

“ This treatment has been to me a new ligh t.I use it now withou t fear or hesitation

,and th ink

that I have l earned at last how to recreate theblood and how to fat ten. I have quoted one realcase

,my firs t. But th is i s no place nor occasion

to relate cases,or to enter into details, as I shal l

elsewhere but I may venture again to say a wordas to two facts, even at the risk of be ing m inute .During the treatment sl igh t hemorrhages from thenose are not uncommon

,but the return ofregular

menstruation is a better test of the rap id gain inblood. I t nearly always becomes regular, and inthree cases has returned during the first month oftreatment

,after absence

,respect ively

,ofthree, five,

and eigh t years.The gain of fat is sometimes at the rate of

one-half pound a day. I have seen i t reach threefourths ofa pound a day ; but these rates arerare.

“ The appl ications of this treatment are many.

I have used it i n numbers ofcases , selecting atfirst such as had no hopeless organ ic d isease. Ihave also used i t to prepare feeble people for sur

gical operat ions , and within a year I have venturedto treat in this pecul iar way people in th e earlystages of pulmonary phth is is. I have seen as tothese som e notable facts , and have learned that insome such cases rest and over-feeding are of truecurative value for this is one ofthe doctor’s bes tlessons

,that there may be one way or several to a

cure. In the early stages of phthisis we have al lcome to think air and exercise and out-door l ife theone thing needful or hopeful, and I may be thought

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THE CANADA LANCE'I‘.and v igor

‘

ofthe attack has to be taken into accountWith th is idea clearly being kept in view

,and

with al l abatements for mildness of the symptomsin any particular case

,i t yet would seem unwise on

the practitioner to inform any male patient sufferingfrom hard chancre or mucous tubercles, that hehas any righ t to marry before some three or fouryears at least have passed over h is head.

”— l e

DEATH FROM CHLOROFORM .— Adeath from chlo

roform occurred at Mercer’s Hospital,London

,

June asth. The patien t was an in temperate man,

a wa iter and bill iard marker,aged 2 7 years. The

occasionfor the administration ofthe anaestheticwas the firing ofthe knee j oint for synovi tis. Accord ingly, on the morning ofthe asth, after havinggiven the man

,who was rather nervous and exci t

ed , an ounce Ofundilu ted whiskey, chloroform wasadmin istered by the experienced chloroformist tothe hospital (the apothecary) , by means Of a Skinner’s inhaler. Very soon the patient began tostruggle

,and with in three minutes was und er the

influence of the anaesthet ic. Almost s imultaneously, and before any operative steps were taken , apecul iar change in the man ’s expression was

noticed ; the face became l ivid , and at th e samemoment i t was reported that the pulse had becomevery weak , and then that i t had stopped. Thetongue was immed iately drawn forward the faceand chest slapped w ith wet towels

,a stimulating

enema given , and nitrite ofamyl h eld to th e nostri ls

, etc. Artificial respiration by Sylvester’smethod was at once commenced

,and vigorously

carried on for an hour and fifty minutes ; bu t although a few gasps and inarticulate sounds occurred

,

n o S ign of returning l ife appeared to reward thepersevering efforts which were had recourse to forh is restorat ion . An inquest was held on Wedn es

day and the j ury,having heard the medical evi

dence,returned a verdict that the deceased d ied

whilst under the influence Ofchloroform,in couse

quence offatty disease of the heart.” The postmorfem examination revealed an advanced stage offatty deposi t ion upon and degeneration of

,an en

larged heart. There was also a layer offat on th epericardium , and old pericardial adhesions.

’

Thewalls of the heart were pale

°

and flabby ; that ofthe righ t ventricle was th inner than normal . Thecavities were dilated and empty. The valves wereperfectly healthy, but the aorta was atheromatous.The lungs were extremely congested

,and the base

ofthe right, hepatiz ed and bound down by firm ad

hes ions. The ap ices of both contained numerousnodules ofcaseous matter, which in several placeshad softened into smal l vomicae. The liver

,kid

neys,and Spleen were enlarged and congested .

There were chronic gastritis and inflammation of

and jury and the legal adviser Of the deceased widow expressed their opinion that the chloroform wasproperly administered

,‘and that no blame was i n

any way attribu table to any of the s taffOf the hospital — JV. Y. M edical R ecord .

INDICATl ONSFO R THE U S E OFTHE CATHETER. .

—Very recently Sir Henry Thompson remarkedthat there are two indications wh ich point to thetime for commencing the habitual use ofthe catheter for emptying the bladder in cases ofObstruetive enlargement Ofthe pros tate. Firstly, wemust know the amount of residual urine habituallypres ent, that is the quantity left in the bladderafter the pat ient has pas sed all he can by h is efforts ; and, secondly, we must Observe th e degreeoffrequency

,by day and by night

,with which he

passes water,but especially during the latter per

iod .

” He says,Let us suppose a case in which

eigh t ounces always remain behind that quant itysuffices

,in my opin ion

,to

'

make it desirab l e thatthe patient should at once commence the daily useof the catheter.” The second indication— thefrequency ofpass ing the u rine by day and especiallyby nigh t— i s a symptom that demands attent i onand prompt resort to the catheter. The interruption Ofsl eep and res t in elderly persons rapidlyderm ines the health .

There is no suffering so severe as that from re

ten tion of urine. The greatest l iving author on

the geni to-urinary organs,Sir Henry Thompson .

says,

“ I f,after twenty-four hours of agony , rel i ef

follows your dextrous use Ofthe catheter, and thetwo or three p ints which the patient was unabl e tovoid are withdrawn by your hand , he tells you thathe is in heaven— a common expression with suchpatients ; and he will never doubt for a momentthat you were the author of h is translat i on .

” Ihave repeatedly been more warmly and gratefullythanked by the patien t and his family for rehevmg ,by the use Ofthese soft catheters, th e retent ions of urine thanfor any other professional serv1ee.

If you will consider the Obstruction that exists incases ofenlarged prostate, I am sure you W i l lnever attempt to force a sol id instrumen t by suchan obstruction

,but wil l in such cas es rely on one

ofthe soft catheters, wh ich can , as I havebefore stated

,worm i ts way by an enlarg

ed prostate without the slightes t inj ury to the us

sues.Professor Van Buren reports cases Ofprostatic

enlargement which have been -kept under controlfrom twelve to twenty years by the systematic useOfthe catheter four or five times a day. AS a rule,at the appearance of the first symptoms of the d isease the patient should commence rel ieving thebladder four or five times in every twenty~four hourswith one ofthese flexible instruments. I f

,th is in

the mucous membrane oft he ileum . The coroner [ j unction is Observed l ife may be much prolonged

THE CANADA LANCET.

or chemical cau ses ,warm water 1njectionS in to the bladder are of un

mation of the bladenlargement warmcacious in cleansmg

they wil l Often get a nigh t Of undisturbed sleep.

But, besides, the dam formed by the pros tatic

growth causes retention ofthe urine,and hence

decomposition ofi t with resulting cystic inflamma

tion and the probable formation ofa calculus .Warm water inj ections are necessary to cleanse thebladder, thereby preventing such formation ; thesoft catheters

,together with a fountain syringe

,are

all that are required for the inj ections.— A’

z7zer z'

ean

THE SURGIC AL TREATMENT OFEMPYEMA.

cause more anxiety to ‘

oftreatment considerably aggravates th is anxiety.

T ime is often wasted while half measures are being

curative treatment is adopted . When the ex istenceofpus within the pleural cavity has been estab‘

l ished , there can be no doubt ofthe necessityforits evacuation . The question remains , how canthis best be accomplished ? Aspiration i s the easiest method, and in ch ildren is frequently very suc

oflarge abscesses that i ts most decided triumphshave been won . Where only pure non-i rri tat ingair is admitted to the pleural cavity the suppurationat once or soon ceases

,and the patient escapes the

danger ofblood-poisoning. A drainage-tube shouldbe employed

,and care should be taken that i t be

passed j ust into th e pleura ; but i t i s unnecessarythat any Of the tube S hould be free in the cavity.

Several cases are on record where these tubes havesl ipped into the pleura

,and have given rise to

trouble in extraction . This accident can be qu iteprevented by adopting the s imple expedient oftransfixing the outer end ofthe tube with a harel ip pin , which crosses the wound and effectuallyprevents the tube passing in ; and if the ends ofthe pin be secured to the chest by strapping, i tequally prevents the tube being forced out of theOpening . The tube should not be withdrawn untilal l secre tion from the pleura has ceased — Lancet

,

May 5 , 1 87 7 . abstract ofMea’

. S cience. )

PROLAPSUS R ECTI. -This i s a rare cond itionamong ch i ldren. It i s of vary ing grades , as ofpartof the mucous membrane

,or the whole Ofthe rec

t um up to the s igmoid flexure. The latter is usual lyafter theformer has been al lowed to pass unnoticedfor a long t ime. In most cases, however, we find

only a. partial prolapse occurr ing after constipation .

Catarrh of the large intest ine may be a cause of prolapse

, by the frequent stools and the tenesmus occurring coincidently w i th the wasting ofthe muscular part of the in testine. In rach it ic ch i ldrenw i th such a catarrh

,i t not infrequently occurs, d is

appears for awh i le, and reappears w i th the exacer

bation ofthe catarrh . Such cases are best treatedby treating the intestinal catarrh , and by i rrigat ionof the in test ine w i t h water, beginn ing w i th a temperature of 24

° to 22° (C . ) and descend ing to thatOffresh spring water.In chron ic cas es as tr ingent i rrigat ions w ith solu

t ions of alum and tann in S hould be used.

S uch are also benefited by local treatment w ithcau terants. The prolapsed bowel may be l ightlytouched w i th n itrate of s i lver in substance, mak inga c ircle round i t and rad iat ing l ines along the ax isof the in tes t ine after th is i t should be replaced andconfined w i th a su i table bandage. Th is should berenewed every th ree days for three or four weeks.I f such proceed ings do not effect a cure, one shoulduse the hot i ron

,especial ly when the prolapse has

lasted long and the sph incter an i is paralyz ed. The

i rons used sh ould be smal l and appl ied at the l inewhere the mucous membrane covers the commonsph incter. Strychn ia and nux vom ica by hypoderm ic inj ection or supposi tory he does not th ink Ofmuch value .

The replacement of a prolapsed rectum requ irescare. I f a ch i ld is alarmed and screams and strains,i t is best to anaesthetize h im firs t. One must not

maltreat the intest ine with fut i le man ipulat ions.

18

When the in testine i s replaced i t should be securedw i th a retainer ofsome sort . Dr. Mont i uses

,and

th inks bet ter than any ofthe more compl icated ap

pl iances , a series of strips of adhesive plaster, wh ichcross over the mons veneris and the anus

,con sti tut

ing a sort ofart ificial sph incter. Through the partopposi te the anus he cuts 8. hole, through wh ich thes tool s pass qu i te wel l

,and yet the appl icat ion pre

vents the protrusion ofthe rectum — P1211. M edi cal

Yimer, Aug. 4,18 7 7 .

EFFEC TS OFMED IC INES UPON THEFCETU S .

— In

a paper by John L. Cleaveland,M .D

,publ ished

in Tbe C lin i c, the following conclusions are ad

vanced

Certain remedies,

e. g . ,potassium iodide

,

sal icylic acid, and chloroform , may pass from thematernal into the foetal circulation .

The acute exanthemata,scarlatina

,measles

,

small-pox, and perhaps vaccination , can be transm itted by the mother to th e foetus . Whethersyph il is passes from the mother to thefoetus, orvice versa remains yet undecided. The effect ofmaternal

,mental , and emotional influences upon

the vital ity and developmen t Ofth e foetus is yetundetermined .

As to the therapeutic effects of med icines uponthe foetus almost nothing is known . There is onlyone class ofremedies that is administered with thebel ief Of hope that they will have any effect uponthefoetus,nam ely, syph il is specifics, and the effi cacyofthese is stou tly denied by some.Chloroform is known certainly to enter thefoetal

circulation , but it is not known to exercise any pern icious effects. Zweifel claims that j aundice maybe caused. This, however, i s not proved.

I t has not been demonstrated that morphia passesinto the foetal circulation

,but cl inical experience

appears to prove that in th e hands Of most practit ion ers , and in the vast maj ority ofcases, Opiatesmay be used with safety to the foetus .I t appears , however, on the other hand

,from

the testimony of some observers,that the hypo

dermic use ofmorphia to its full physiologicaleffect produces in the foetus dangerous phenomena,cyanosis

,impaired respiration

,irregular pulse, con

tracted pupi ls,a disposition to S leep, and some

t imes convulsions. I t is Of the u tmost practicalimportance to us al l that this latter point shouldbe de termined — New R emedies .

ETHER AS AN ANzESTHETIc.— The Doctor has

the following excellent Observations on this subj ectI t has always seemed to us,

” i t says,“ the

height offolly to declare there could be no dangerin any anaesthetic. The lesson taught by the latedeath from nitrous oxide has, i t i s to be hoped,been well learned

,and we shall in fu ture hear less

ofthe absolute safety ofany agent capable ofdep riv ing a person ofall sensation . Some cases in

THE CANADA LANC ET.

DYS ENTERY TREATED SUC C ES S FULLY BY LARGEDOS ES OFIPEC AC UANHA— G IVEN BY THE NON EMETIC PLAN . Forester. ( T/ze B oscoa M ed and

S urg j ozcr . Feb. The following cases ofdysentery treated by ipecac are of pecul iar interest

,

says the author,because ofthe prevalen t notiori

that large doses ofth e drug cannot be given beneficially to dysenteric patients without be ing followedby emesis. Case one

,was treated by twenty-five

grains ofpulveriz ed ipecac. every six hours, suspended in syrup oforange peel , and patient instructed to remain in the horiz ontal position , andto abstain from food and liqu ids during th e treatment.The ipecac. i f rej ected, to be repeated every

twenty minutes until retained. The other cases reported were treated as the first, and the resul t obtained in each was S peedy convalesence, fol lowedby recovery — C kicagoM ed ical j our nal.

which ether has been followed by alarming symptoms have lately been recorded . They have beentermed syncope, but th e word is not appropriate,as the heart continued to beat after resp irationceased. This is what should have been anticipated .

When death is produced by ether th e animal ’sheart continues to beat long after the arrest ofrespiration. The pulse i s quickened by ether andmaintains its force through a long state ofanaesthesia. In these facts l ies the safety ofether.But it Should never be forgotten that there i sdanger at a certain stage, and the danger i s fromthe S ide ofthe respiration , wh ich at length ceases.Stertorous breath ing proceeds from paresi s ofth emuscles ofthe palate, and should lead to the etherbeing suspended. S O respiration growing moreand more shallow and less frequen t is a warningand should not be Overlooked. I t is very rarethat th e heart fails— perhaps never. Pal lor is raretoo

,and should excite attention if i t occur. But

we repeat,the danger ofether i s from the S ide of

respiration,that ofchloroform from the heart, and

this fact goes far to explain their relat ive safety.In chloroform narcosis the danger is much moresudden . Ether gives warning.

”— H os,oi tal G azette.

LUXATION AT THE H IP-j oINT— EASY METHOD OFREDUC TION.

-Place the patient on h is back uponthe floor ; flex the femur upon the abdomen unti li t is brought at right angles with the pelvis then ,stand ing astride ofthe patient, clasp the hands umder the legs close up to the thighs and suspend thebody ; when the body has been raised free fromthe floor

,the sound limb can be so balanced against

the leg ofth e surgeon that the entire weight Of the

THE CANADA LANGET.

i ll , and i t was bel ieved that the principl e was apJlicable to all forms Ofdislocat ion a t the hip j oin t.The theory was that th e so called Y l igament was:he obstruction to reduction , an d that , when i t wasmost fully relaxed , as i t coii ld be by flexing the‘high at a righ t angle with the pelvi s , the weigh t Ofh e body was sufli cien t to overcome th e Obstructiontud bring th e bones into th eir proper relation . Antdvan tage which the method possessed over alli thers was that i t made the patien t p ar ticeps cr zmzzi r

,and as a matter ofnecess i ty

,he became one of

he defendants In the suit, in case any one was subequently disposed to suefor damages.IRR IGATION IN CHRONIC CYSTITIS .

— Dr. Jack:on ,in Boston Medical and Surgical Journal

,re

aorts two cases ofchronic cystitis successfullyreated by constan t irrigation . The means usedrere a vessel containing water, a double catheter,md india-rubber tubing sufli cien t to convey therater to and from the bladder. The flow was regu1ted by a stop-cock at tached to the reservoir. TheOS i tion ofth e vessel Should be such as not toause pain by excess ive pressure

,but i t is neces

try that th e bladder should be fully distended atmes, in order that the whol e surface may be1oroughly cleansed. About a barrel Of water iseeded in twenty-four hours. O f the first case

,h e

tys that the usual method of interm ittent irrigat ionas adopted, and continu ed about two months,i thout benefi ting the pat ien t

,at th e expirationfwhich t ime constant irrigation day and night by

ieans of water about th e temperature Of th e bodyas substituted . A constant flow of water into theadder was kept upfor three days

,when the cath

er was withdrawn and th e urine examined,which

,

1 previous examinations,was alkal ine

,but now

,

r the fi rs t time,was acid. Irrigation at interval s

,

trying from two to three days, was kept up for)0t one month

,at the end ofwhich time the case

as discharged cured . Case two was not unl ik etime about onerigation , at interwas suffi cien t to

SWELL INGS AND

de P ar i s Dec. 2,1 8 7 6 .

M . Qu inart, oftheadvises

,l ike Nelaton

,to

ack s imple engorgement ofthe glandular tissuethe outset wi th a series ofbl is ters

,but he em

rys the same treatment when pus has already

It is threatened, he punctures the sac at the mostaenden t part of the tumor

,where the instrumen t

l traverse a large extent Ofheal thy cellular tissue.ten the sac is emptied it is covered

,whatever i ts

19

exten t, by a bl i s ter wh ich overlaps i t on al l S idesby one or one and a half inches. The followingday, the blis ter is dressed with mercurial Ointment ;as soon as the skin begins to cicatriz e, a secondbl ister is appl i ed and so on . Among other cases,M . Quinart has cured an abscess that extendedfrom the angle Ofthe jaw to th e clavicle , and whichcontained over ten and a hal f ounces Of pus. Thetumor was punctured j ust above the clavicl e, andthen entirely covered by a large bl ister. The secondday

,the l ittle wound was reopened by means ofa

s tylet,and a quan ti ty ofserous pus escaped . The

third day,th e greater part ofthe sac’ was closed ,

the fluid that accumulated in the most dependentpart was reabsorbed

,and no mark ofthis immense

abscess now remains,except a small cicatrix above

the clavicle. —~Detr oi t M ed . j our nal.

PAPER SPL INTS .

'

— Dr. M . R . Speare, OfR ochester, N . Y. , sends us a sample ofhis paperspl ints . He writes —I employ strong manilla

paper and book binder’s starch

,which consists of

flour and water boiled to the consistency ofj elly.I firs t prepare my paper by cutting i t i nto stripslong enough to encircle the l imb at i ts greates tcircumference

,and varying from half an inch to an

inch and a quarter in width . Having an assistan twith the starch and a brush ready

,I apply a flan

nel roller asfar as I wish the splint to extend ;then smear th is with the starch

,apply the strips

ofpaper— after S tarching —th e same as a manytailed bandage

,brush th is over with s tarch again ,

and apply another layer as before,un til I get the

required thickness,wh ich is usually s ix or seven

layers,according to the firmness ofth e paper

used . The whole process wil l occupy about fifteenm i nu tes.When this is dry

,which will take two or three

hours,by th e aid ofhot bricks or sand bags on each

side Of the S plin t,i t is very l ight and comfortable ,

fiting as n icely as a stocking, and is as firm as th esame th ickness of wood — M ed ical 69s S urg ical

R epor ter .

N ITRATE OFP ILOCARP INE.— Permit me to cal lth e attention ofyour readers to the very conven ien t means now accessible for producing th ein imitable diaphoretic and sialagogue effects i abo

randi. I refer to th e n itrate ofi ts alkaloid, pilocarpine. This may be administered subcutaneouslywithout trouble

,and produces with in five minutes

a distinct moisture ofth e sk in , and in afew minutesmore profu se sweating and flow ofsal iva, las tingfor some hours .In a case ofBright’s disease (parenchymatous

nephritis Ofan extreme degree) , where the hot-airbath failed to procure diaphoresis, and where jaborandi in infusion was vomited, the subcutaneousinj ection ofa l i ttle more than one fourth ofa grain ofn itrate Ofpilocarpine produced abun

20

dan t sweating and copious flow Of sal iva. T he in

jection was several times repeated , as much , however,for th e great rel ief afforded by its sialagogueaction to the distressing dryness ofth e mouth asfor the mitigation ofthe general symptoms

,although

the patien t at first expressed h imself as feelingmuch more comfortable after its action .

I t has been used with similar resul ts in two othercases

,once in each. The therapeutic value of this

drug cannot be considered at presen t as well determ ined ; but such a convenien t method of admini stration ought soon to furn ish suffi cien t dataforthis purpose.A solution ofn itrate of pilocarpine grs . i iss or

gramme,aq. d estill. 5 i . or 4 grammes, Of

which S ix minims or C C . may be inj ected,is of

convenient strength — D r . Edes,B oston Med .four .

DIALYzED IRON.—Ifal l that i s claimedfor th is

preparation be true, i t is by far the most valuableform in which iron can be administered in manycases. There is h igh authority in support ofi tsvalue. Becquerel

,th e celebrated French scientist

,

gives i t unqual ified praise,and i t has been used in

France for some time, with satisfactory results. I thas been more recently introduced into Americanpractice, and appears to ‘be growing rapidly intofavor in Philadelphia and elsewhere. I ts mode Ofpreparation is well known to chemists

,and there is

no secresy in connection with it. I t is a coneentrated solution ofperoxide Of iron

,without Oder

,

and without the styptic taste Of ferruginous preparations i h general . I t may be given in the samedoses as the ordinary perchloride tincture. AS achemical antidote to arsenic, i t i s claimed to befully equal to the hydrated sesqui-Oxide

,and i t has

the advantage ofbeing always ready for immediateuse. Becquerel says Of it

,that i t produces no gas

tric dis turbance ofany kind,and no constipation ,

and that i t never discolors the teeth . Not yethaving had an Opp ortunity Of giving it a sufli cien t

trial , we cannot speak from experience,but the

testimony in favor ofi t i s too s trong to be disputed.

-R acifi c M ed . j our nal.

THE M edical P ress and C i rcu lar says London,

the greatest C ity the world ever saw ,cov ers

,with in

a fifteen-mile radius ofCharing Cross,nearly 7 00

square miles. I t numbers more thaninhabitants . I t comprises foreigners fromevery quarter ofthe globe. I t contains more R oman Catholics than R ome itself; more Jews thanthe whole Of Palestine more Irish than Dubl inmore Scotchmen than Edinburgh ; more Welshmen than Card iffI t has a birth in i t every fiveminutes

,and a death in i t every eigh t minutes ;

has seven accidents every day in i ts 7000 m iles ofs treets has 1 23 persons every day, andannually, added to its population ; hashabitual criminals on i ts police register has 23,

THE CANADA LANCE ’

I‘.

000 prostitutes has as many publ ic-houses as

would,i f placed side by side, stretch from Charing

Cross to Portsmouth has drunkards annually brought before its magistrates has as manypaupers as would more than fil l every house inBrighton has 60 miles ofopen shops every Sunday ; and has an influence on the world rept esented by the yearly del ivery in its pos tal districtsof2 letters.

S IMPLE METHOD OFTESTING THE PUR ITY OI

CHLOROFORM .-Dr. Lueke

,ofS trasburgh, g i ves

th e following simple method oftesting the puri ty‘

ofC h loroform : Immerse a small piece ofth inwhite blott ing-paper into the C hloroform ,

and therlet i t dry in the air. AS soon as al l the '

chloroforrrhas evaporated

,the paper will not present the

l eas t smel l if the chloroform is pure. I f there isany acid smell perceptible

,it indicates the presence

ofbutyric acid in the chloroform , and as a rule hasth e strong characteris tic Odor Of that substance .

New R emed ies .

TREATMENT OFFI S SURES OFTHE N IPPLES DU RING LAC TATION . Buttler. (Tbc G lzio M ed . R e

cord,May

,When fissures ofthe nipples

are not due to some constitutional cause,t inct. 01

benz oin freely appl ied to the parts will,in abou ‘

five to ten days,eflfect a cure. Only the first ap

pl ication is painful . T inct. Of benz oin forms 4covering on the surface of the n ipple, and so pro.teets it from the ch ild . Lactation is never interrupted by the above process 0

PROF. GRO S S says

remedy of stupendous consequence to therace a remedy w i t/zout w lzic/z i t would besible to treat disease with any prospect ofin almost any case, nose/ever s i nzp le.

”

of the sun ienteritis, etcenforced cold bath ing In these cases.

Professor Nathan R . Smith,the disti

surgeon and medical practitioner of Bal tima t his res idence in that ci ty, in the 8 1 5 t

his age.

THE death , at Paris, ofDr. Caz enavetrious dermatologist, i s announced.

THE CANADA LANCET.

THE CANADALANCET.

AMonth ly Journal ofMedi cal and Surgical Sci enceIs sued Promp t l y on t h eFi rst ofeach Month .

AGENTS .— DAWBON B R 08 . , Mon treal J . 61 A. MCMILLAN ,

S t . John ;NB .

J. M. BALDW IN ,

805 Broadway , New York, and BALLIER E.

TINDALI. C ox, 20Ki ng Wi l l iam s t reet , S trand , Lond on , Englan d .

TOR ONTO ,SEP. I

,1 8 7 7 .

DEFECTS OF HOUSE DR AINAGE AND

THEIR R EMEDIES .

An admirable paper on th is subj ect wil l be

found in the annual report Of the State Board ofhfor Massachusetts , January 1 8 76, written

S . Philbrick, C .E. He points out th e

ty for the removal of sewage with all possible

Every device by wh ich any part ofi t i shoarded or retarded in or about the premises is to

be carefully avoided. A frequent mistake is madedrains, arising from

e more l ikely to be

come choked. The fact is, that al l increase ofS iz e above the requirements ofcapacity i s anactual injury, by diminish ing the scouring powerOfthe current so that if laid with a fal l Of two

feet or more in a hundred, a four in ch pipe is

better than a larger onefor a house drain , becausewith the limited flow th e smaller one would scour

bett er than the larger one. I f rain water i s admitth e roof gutters

,either for C onvenience or

a larger s iz e is perhaps needed, but sixample even then , for any ordinary housefthe fal l i s less than two feet per hundred

,

may be needed. Dr. Latham says that

to be self-cleansing, the house drain Should

at the rate Of three feet per

th is velocity,a four-inch drain

about one foot in a hundred,

about one in a hundred and

S which drain into sewers,the

tside Of th e house wal ls

after i t has col lected all

21

portance ofth is rule ofdisconnection between th ehouse pipes and the ou tside drains.” The Medical

Officer ofth e Privy Council , London , says, “Thiscondition ought to be insi sted on , that every

private drain be prop erly trapped and ven tilated

in relation to the common sewers .” The gas wh ich

arises in foul drains is Of a singularly l igh t character,

and has a tendency to ascend or draw towards any

heated part ofa house . Hence it Often occurs tha thou ses in towns situated on the h ighes t grounds

are more unheal thy than those in val leys,th e fou l

air rises to th em th rough the drains. As during

th e greater part ofthe year th e internal temperature ofan inhabited dwell ing, and especially ofsome parts ofi t, i s much h igher than the surrounding temperatu re

,i t i s Obviou s that the gas natural

ly ascends to th e l iving rooms, especially i f duringthe winter an d autumn they are warm and com

fortable. The water-closets are also generally on

th e bed-room floor, and it is more inj urious to

health to sl eep in foul air, than to be in i t during

th e day time . I n planning house drains,they

should be got outside the walls ofth e house asdirectly as possible. In

“

public insti tutions or other

large build ings,where a large number Ofreceptacles

of sewage is provided, the main d rain for the col

lection ofth e whole should be outside the walls,wherever pract icabl e, for th e reason that fewerj oints ofpip e, and fewer chances of l eakage fromimperfect work

,would thus occur within the walls.

The pipes should not be buried under the cellar or

basemen t floor,but should be readily accessibl e for

inspection . They can generally be placed along

some wall or partition , or hung from the ceil ing

where their j oints can al l be readily seen , to be recalked and painted whenever necessary Dr. Parkes

says it should be a strict rule, that no drain pipe of

any kind should pass under a house. If there

mus t be a pipe passing from fron t to back,or the

reverse,i t is much better to take i t above the base

men t floor than underneath , and to have it exposed

throughout i ts course. The water closet i s u sed

by thousands who know littl e Of i ts mechanism,and

who consider i t as an automatic arrangemen t,

nee-ding l ittle or no attention . But

,as it is no

more perfect in i ts way than al l other works of

human hands,i t has many faul ts and weak points,

part icularly in th e form ofth e pan close t, now sogeneral ly used. I t therefore behooves the arch i

tect who plans a house for the rich man , the

22 THE C ANADA LANC ET.

mechanic who plans his own , or who build s to sellagain

,and lastly the householder and head ofthe

fam ily h imself,to know someth ing Of the general

principles Of its construction , and to avail h imself

Of such knowledge in planning, building and tak

ing care ofa house. There seems to be a de

plorable lack in th is respect, for instead ofwaterclosets and drains being placed so as to insure the

getting rid of the refuse with safety,we often find

poisonous gases emitted from them,and conducted

all over the house, by an ingenious system of pipes ,floor spaces and partition spaces in our plastered

buildings .

I t is to be regretted that among the hundredsOf patented inventions, recently brough t before the

public,one of the most defective and dangerous

ofthem all should have got into such general use,v iz .

,th e ordinary pan closet. Latham speaks of

them in his Sanitary Engineering as cumbrous appl iances which cannot be introduced into

a house without creating a nu isance . I f thewater closet can be located near a chimney which

is sure to be in constant use, as the kitchen

ch imney,the evil can be abated by pass ing a z inc

tube ofsome three inches in diameter, from thespace under the water closet into the chimney flue .

Where no warm chimney can be had near enough

to be used,the draught tube can be run directly

through th e roof,with some ventilating attach

ment at its top to encourage the upward draught of

air. I t is .always advisable to provide at least a

part of a window directly over every water closet.

The pan and hopper closets which are often found

tucked into corners , under stairways , and in other

dark places,without special ventilation, are sure

to become nu isances,and poison all their sur

round ings.

PR EVENTION OF WOR MS INCHILDR EN.

l l h h fare not preventable

Whatever wn ass i st t e mem ers 0 our pro prophylaxis is in thefess ion engaged in constant and extens i ve practice, beefand sausages which are the0 o 3

must be worthy Ofnot i ce at our hands. In V i ewofcarrying the eggs into the system

ofthe quantities ofanthelmintic remedies sold bychemistsfor popular use in famil ies, and the quan INEBR IATEs r éThe American Associationt ity Of medicine prescribed by physicians i n ad Cure ofInebriates wil l hold its eight annuald ition thereto

,any knowledge of a hygienic or

prophylactic nature should be widely disseminated.

’ papers and bus iness wil l be presented.

I t i s often well to recall the observation of me :of a past age, on a subject. About a centu ry ag~

th e eminent Dr.s

R ush ofPhiladelph ia,mad e

series of experiments upon common earth wormsas most nearly all ied to those which infest the bowels of ch ildren

,for the purpose ofdiscovering wha

agent would most speedily destroy their l ife,am

which could be used as a vermifuge or worm m ed

reine. From these experiments he discovered thafresh ripe fruit is the best preventive against wormsand the most speedy and effectual poison for themAny physician who may choose to put this theor

to the test,will find it true in practice.

Dr. R ush ’s experiments proved that worms wi ll ive longer in some solutions known as poisonousthan in the j uice Ofsom e Ofthe most harmlessarticles of food : thus in a watery solution Ofopiumthey l ived eleven minutes ; in an infusion ofp inlroot

,th irty-three minutes ; while in the j uice 0

red-cherries they died in six m inutes in the j uice 0

black-cherries in five minutes ; in the j u ice ofredcurrants

,in three minutes that Of goose-berries ir

four m inu tes ; whortle-berries, in seven minutes

and raspberries in five m i nutes.

I t may be added in a word that any

acid is destructive to the various

parasmc l ife and as such th e various

may be safely and j ud iciously recA child’s digestion should never be

become impaired by over—eating or badfavours the generation ofworms.

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24

French-Canadians amounted to 452 5 ofth isnumber 364 were under 1 0 years ofage

,and 88

above that age . Among the Engl ish-speaking 7 6deaths took place— 4 1 being under 1 0 years

, and

3 5 above that age. Among the Protestants therewere 80 deaths, 5 1 were under 1 0 years and 20

above. The large proportionate number of deaths

in one ofthe wards was attributed to over-crowding, and the existence ofa large number ofbutcheries, glue, soap and candle factories . This

state ofthings will be brought prom inently underthe notice of the Board of Heal th

,for emendation

.

CHOLERA MORBUS AND D IS EAS ES OFSUMMER,

— A majority ofthes e attacks are due to the use ofunripe and indigestibl e fruits stal e or decaying

food, such as tainted meats or fruit already

beginning to decay,and from over-eating and

from making use ofunseasonable food,too rich

and heavy for hot weather. I f people could be

almost vegetarians during th e hot season,they

would be al l th e heal th ier, sprightlier and happier.But they go on gormandising unti l nature revol ts

,

and a severe attack of bil ious diarrhoea i s th e re

sul t,or they go and drink wines and ales

,or per

haps someth ing stronger, until indignant and insulted nature puts in her protest and resents such

il l-usage .Great atten tion should be paid to the diet es

pecially during the summer months . Live righ t

and you wil l be al l righ t ,” is an old truism that

holds good here . Eat to l ive,

” said one,not

l ive to eat. This rule being observed,and pro

per diet sel ected , nothing more is necessary. Even

in the management ofchildren , take care of thestomach and the heal th will take care of itself isa truism which seldom is at faul t.

BREWERY GRAINS As FOODFOR Cows — Thecustom offeeding brewery grains to cows to increase the flow ofmilk is very common in al l largecities . The resul t is an excess of quantity for the

t ime being, with a very decided deterioration inqual ity ; but, sooner or later this food, when us ed

i n considerable quantities, produces a poisonouseffect on the animals, and renders the milk whol lyunfi t for use . The cows, if fed on grains alone,become covered with sores and even tually die.The poisons that are used in the manufacture ofmal t l iquors, such as sulphuric acid, cocculus indicus

,opium

,copperas, alum , and strychn ine, natur

THE CANADA LANCET.

ally settle (especially th e dregs ofthem) , in th.

grains. This furnishes a clue to the increase (infant mortal i ty in s large cities. The Board 0

Heal th in Brooklyn has prescribed al l swil l m ilki . e.

,m ilk from cows fed on the sw il l or rabbist

from breweries and dis tilleries. Tons of brewer)grains are constantly being fed to cows in our largecities

,and if the various Boards ofHealth were at

all equal to their duty, th ey would at once proh ibi

the sale of milk so produced.

PAPER LEGS AND ARMS .— Paper is al ready being

made use of as a substance out Ofwhich to man

ufacture articles ofdurabil ity and strength , even tccar wheels and flour barrel s

,which latter for l ight

ness,durab i l i ty

,tightness

,and cheapness, are said

to be superior to wooden ones,and the former are

said to be safer from fracture, and qu ite as durable

as iron .

Experience ofth is kindmuch the best art icleart ificial l imbs

,becau

heavy and

ligh t are

rels out of paper, and give u s

tificial l imbs than we yet have

thereby confer a much needed boon upon

weary sufferer from the present clumsy ap

MED IC O-LEGAL CAS E — An importantlegal case has lately been decided in the

Court in Charlottetown,McLure received a severe inj ury to his hand

wrist i n October last by a powder explosion ,appl ied to Dr. McKay for treatment. The

treated the case with the u tmost skill and care,from want ofcare and atten tion on the part ofpatient

,interference with the dressing

,and the

early use ofthe hand , i t afterwards became wand useless . An act ion for mabrought against the Dr. , and thelaid at I t was shewn in the

th e Dr. had treated the patient inskilful manner

,and had

th e case. I t was al so sh

THE CANADA LANCET.

ing about an unfavorable resul t. After a trial

wh ich lasted four days,the Dr. was honorably

acquitted. We are glad to learn that McKay’s

reputation wil l not suffer by th is trial . The evi

dence went to shew that h e was not only an intelligen t and skillful practitioner, but an excellentman ofbusiness.LAC ERATION OFTHE PER INEUM.

-The two cl in

ical lectures by Dr. Goodell,of Ph iladelph ia

,on

Laceration ofthe Perineum,i ts prevention and

cure,” are most valuable and original

,and are wel l

worthy the perusal ofal l accoucheurs . Among thecauses he says— and we agree with him manylacerations are owing to the common mistake of

making such long continued and firm pressure on

th e perineum as to make i t hot, dry, and unyield

ing, and also to prevent i t from undergoing an

equable d ilutation .

” In the great maj ority oflabours the perineum does best when let alone.”

He adds, In the maj ority of cases oflacerationin wh ich the anal sph incters are involved

, you will,I am sorry to say, find that the labor has been anins trumental one. Yet there are cases in wh ichthe very use ofthe forceps protects the perineum .

”

Still he goes on to say,I have seen so many bad

rents attending the use ofthe instrumen t,even in

practical hands, that I cannot withhold the opin ion

that, in the majority ofcases,nature can aecom

pli sh final del ivery ofthe head through the softparts much better than the physician .

My advice to you, therefore, is that, other things

being equal , as soon as the perineum is well

dilated, you should remove the forceps .” As an

ounce of prevention is worth a pound of cure,he

says,“ apart from a direct and retarding pressure

upon the presenting part itsel f,the only manual

aid that I permit mysel f occasionally to give is asfollows. Insert one or two fingers ofth e righ thand into the rectum, and hook up and pull for

sphincter an i toward the pubes. The

the same hand is meanwhile to be placed

upulously avoiding all

m .

” This method heen ts of del i

not detected at once,

inconvenience to th ee reputat ion of the prae

e i t, therefore, an inflexthe vulva, and visually

25

examine the perineum,and unl ess the rent is

simply cutaneous or very sl igh t indeed, you must

perform the primary or immediate operation, that

i s, you must a t once sew up the wound ”

. He

uses wire sutures with an inch deep of hold.

GER M S or D IS EASE — There seems much reasonto fear, says the Lancet, that too l ittl e attention

has been bestowed on th e important subj ect,What becomes of germs of disease after a cleans

ing process ?” Fil th is washed away, but where !I f water holding the poison in suspension is

thrown into ordinary drains,i t wil l become the

agent for dis tribu ting disease. This is a very

grave consideration . Disinfecting, properly so

cal led, i s not a precaution commonly carried out.

I t is generally deemed suffi cien t to purify the particular article s supposed to be foul

,without regard

to what th e de stination of the germ s removed maybe. I t is very doubtful whether th is particular

point receives a due share ofthought in publ icinstitutions. Certainly there is room for improve

ment in the domestic and laundry methods of“ purification . The only effectual measure forarresting the spread ofinfection is one whichdestroys the vital ity of the germ where i t i s found.

INS PEC TION OFTENEMENT HOUS ES IN C IT I ES .

— We would l ike to s ee the regulationfor th e san itary inspection of tenemen t houses in vogue in

Glasgow, universally adopted, because no class ofpeople are obl iged to submit to so great injustice

as the class occupying tenement dwell ings inlarge ci ties . Leaky roofs

,cracked wall s

,paneless

windows, doors withou t proper locks and hinges ,walls and ceil ings requiring repairs

,badly arranged

sinks and water closets,imperfect drainage

,are

only a few ofth e inconven iences th is class is subjected to. They should al l be regularly cleansed

and whitewashed with l ime was]: (not papered)once or twice a year

,under direction of the san i

tary offi cers, to preven t harbouring diseases orspreading epidemics, and a prin ted l ist ofsanitaryinstructions kept pasted up in every dwell ing by

order of the Board of Health. In Glasgow,al l

h ouses with in certain l imits ofsiz e are under sanitary pol ice inspection . Every door bears the re

gister ofthe number of cubic fee t ofspace contained in the dwell ing, and the number ofinhab itants i t is l icensed to contain. This should be

burned in to the wood to prevent removal,and is

26 THE CANADA LANCET.

mos t effi cacious in prevent ing over-crowding .

Three hundred (300) cubic feet of space is allowedfor each adult

,and one hundred and fi ftyfor each

ch ild. Ordinary dwellings and lodging-houses aredistinguished by the character ofthe marks or

t icket.

COMPARATIVE LoNG EVITv.— Ir is general ly sup

posed among life insurance peopl e that women ’s

l ives are shorter and more precarious than thoseofmen . In View of th is i t would be wellfor suchauthorit ies to furnish an explanation for the circums tance that women furnish most examples ‘of

prolonged longevity, as found in the collection ofth e following stat istics Offi cial documents es

tabli sh that, per million inhabitants, there wil l be

found who have attained their 6oth year in

Jtaly ; in Great Britain ; in Hol

land ; in Sweden ; in Denmark ;in Belgium ; and in France . Of

centenarians , there are 1 5 per mill ion in Great

Britain in France ; . 7 in Belgium in Sweden

,and in Holland.

QUIN INE W INE,ITS COMPOS ITION .

— Quinine

wine , which is so extensively advertised and used

at present under the impression ofi ts valuabletonic qual ities , is according to an analysis made by

Dr. Edwards ofMontreal,noth ing better than a

drunkard-maker. Only on e ofthe samples was ofthe general character and strength ofth e offi cialpreparation of that name ordered in the British

Pharmacopoeia. That known as Coll in ’s Quinine

Wine,containing“ Orange wine ,” comes nearest the

prescribed formula. I t is sl igh tly alcohol iz ed andcontains one grain of sulphate ofquinine to eachfluid ounce . That sent for analysis by Mr. John

Gardner,and known as Gardner’s Quinine Wine

i s ofth is character the res t are h ighly alcoholiz edwines

,contain ing only one-third or one-half the

proportion ofquinine . Messrs . John F. Lewis

C o’

s Quinine Port Wine, consist ing of inferiorred wine (colored with log-wood) , citric acid, sugar,tinctures ofgentian and orange , and traces ofstrychnia and brucia

,from a small quantity ofnux

vomica,should certainly be tonic were not its pro

perties in th is regard greatly overbalanced by itsstimulating character— i ts alcohol ic strength being

68 under proof, equal to per cent. ofabsolutealcohol by weigh t and 20 per cent. by volume,

while there is but one grain ofthe alkaloid in threefluid ounces

,surely a moderate proportion . Camp

bell ’s Qu inine Wine consists of Sherry,tincture of

orange peel , citric acid , sugar and sulphate ofquin ine

,the latter in th e proportion ofhalf a grain to

the fluid ounce. I t yielded by distil lation , 20 percent . by volume ofabsolu te alcohol , equal to 64under proof. Lyman’s quinine wine consists ofsherry

,sugar

,citric acid and sulphate ofquinine,

the latter in the proportion ofone grain to threefluid ounces. I ts alcohol ic strength is 7 5 under

proof— equall ing absolu te alcohol— 1 5 .5 by weight,or 1 6 per cent. by volume. Messrs . DevineBol ton’s quin ine wine consists of I tal ian or light

Sicilian wine,ci tric acid, sulphate of quinine, the

latter in the proportion ofone grain in two fluid

ounces. Alcohol ic strength 7 7 under proof; ab :

solute alcohol,1 4 per cent . by weigh t or volume.

Gardner’s quinine wine consists ofl igh t Sicil ianwine

,citric acid

,sugar

,and sulphate ofquinin e,

the latter in th e proportion ofone grain to the fluidounce— as before observed

,he is more generous

than the rest in his distribu tion of the valuable

alkaloid. The alcoholic strength ofthe wine iseigh ty under proof 3 absolute alcohol , th irteen per

cent. by weight 5 twelve per cent. by volume. Fora temperance man th is wine is strong— too s trong.

A retired druggist,speaking of th e above wines,

”

says there are more rim e/1m: than scr ap/es in them

he knows how it is.

AN IMAL VIR U s .

—The “D octor says the prae

tice of’vaccination with human virus seems to benearly fall ing into decay in Belgium , and giving

place to vaccination w ith animal virus. We quote

from the phamplet ofDr. C . R . Drysdale London

th e following statements made before the London

Medical Society last year.In 1 8 73 , 800 of the pract i t i oners in Bel

gium,using vaccine

,sent to the State Department

for suppl ies ofanimal vaccine, and Dr. Warlomont

reports that the poin ts sent out by h im in that yearsucceeded in 96 per cent. of vaccinations, and in

upwards of 60 per cent . oft e-vaccinations.We bel ieve in the superiority ofthe protection

afforded by d irect vaccination, and sympathise

THE CANADA LANCET. 27

He add s, th is holds true also, for the greater number Anaemia, by Drs. Osler Bell,Montreal ; Ad s

ofpatients re-vaccinated by th is means.” These dison ’s Disease, by Dr. Geo. R oss, Montreal ; Onfacts are fully attested by competent observers. large doses ofAcetate of Lead in post-partum and0

other Haemorrhages,by Dr. J . Workman , Toronto ;

TREATMENT OFDYS PEPS IA.— n a M eri zcoe izzr Gastrotomy and Ovariotomy

,by Drs . Fuller, E.

R obillard ,& R ottot,Montreal ;Embolism of Centralentire dietetic treatment Of Artery ofR etina, by Dr. Buller, Montreal ; Expractised, i s not fallacious ; cision of Knee, by Dr. Fenwick, Montreal ; R eOf a highly-animaliz ed regi marks on two cases of Tricuspid Stenosis, by Dr.

men, i t would not be preferable to have recourse Howard,Montreal ; Treatment of Empyema, by

diet. Mr. Smith [Fru i ts and Dr. Ful ton , Toronto. Vesico-Vaginal Fis tula, byDr. Trenholme, Montreal .

fi ts of such a system from the wri ti ngs of em i nentR eports are al so expectedfrom the Chairman of

medical authors who had no particular doctrines to

support, such as Abercrombie, Cheyne, and Thackth efollowmg Comm i ttees

srah and from the cons i derat i ons we have already On Surgery,D13 R O S S»Toronto 9 h Obstetri c

adduced, we think that a strong case has been Dr. R i chardson , Toronto ; on Medi ci ne, Dr. R oss,

Montreal ; on Medical Li terature, Dr. Howard ,Montreal on Climatology, Dr. Marsden , Quebec

MR R ADFORD, Health Inspector Of the City Ofon Therapeutics , New R emedies , ete., Dr. Ful ton,

at the JU 1Y meeting Of the Board Of Toron to ; on Necrology, Dr. O sler, Montreal .that city. reported asfollowS , among Gentlemen in tending to read Papers wil l obl ige

th ings. “ The imperfect construct ion ofby at once notifying th e General Secretary, A. H .

privies was pointed out, and Mr. R adford stated David,M .D. ,

Montreal,mentioning th e t itles

that the death rate in Upper S t Dennis street has thereof,in order that they may be added to this l is t.

caused many enqu iries from residents,some of

whom have become alarmed by these reports. An FAC ULTIES OFTHE M IND — Dr Am She H OHIS ,

O pen gU HY i s supposed to be the cause . He added in the St. Bartholomew Hospital R eports , protes ts“ that a visi t to these places had convinced h im against the growing disposition to t

QO

“ that the present comparatively h igh rate was not closely the several facul ties ofth e mind In the d ifonly due to the condition ofthe premises or to feren t parts of the brain . I t is preposterous ,

”

he“ infection , but partly to the depressed condition ofsays, “

to expect that similar cell s are reservedforC lasses ofth e city. In some cases similar functions in al l human brai ns , knowmg

were found at dinner,and i t was what we do ofthe great diversi ty in man ’s mental

to see the ch ildren with bread culture, his variou s occupations, procl i vi ti es and

in boil ing water as their only food . In tal ents.”

cases the pinched look ofth e l ittl e ones,

sence of the fathers,unable to obtain em

n t, and other circumstances, proved that

number ofourfellow citiz ens are sufferinduced by lack ofproper

made out in its favour.

AS S OC IATION PROGRAMME.held in the new building of

sor Hotel , Montreal , on Wednesday the

at 1 0 a m . The following papers will

The Pres ident’s address . Crime andby Dr. J . Workman , Toronto ; OvarioDr. R osebrugh , Hamilton ; V i tal Statis

THELATE DR . SOMERVILLE SC OTT AL IS ON , M .D

&C , , LONDON .— It i s with feel ings of

sorrow that we have to refer to the death of th is

dist inguished and universally regretted physician ,on the r 1 th July last . He was chiefly engaged in

th e treatment ofaffections of the h eart and lungs,

and in which he was one ofth e most sk il fuld iagnos ists. He was formerly physician to the

Brompton Consumptive Hospital . He devisedand perfected the Differential Stethoscope,which has been much appreciated by those whoseopportunit ies have enabled them to tes t i ts useful

ness , and which , in affections ofthe heart especially has afforded the most satisfactory results. He

28

was a frequent contributor to the medical l i terature

THE CANADA LANCET.

ofth e day, and contributed largely to the proceed ofth e contagion oftyphoidings ofthe '

R oyal Society, &c.,and was the au thor amined by M.G uerin by the e

ofseveral scientific works,particularly that stand He inj ected into a number of

ard work entitled The Physical Examination of from typhoid subjects,and he

the Chest in Pulmonary Consumption and i tsIntercurrent Diseases.”

BR ITIS H MED ICAL AS SOC IATION — The 45 th

annual meeting of the British Med ical Associationwas held in Manchester

,commencing on the 7th

ul t. Dr. M . A . E. Wilkinson was appo inted President for the ensu ing year. Dr. W. R oberts of

Manchester delivered the address on Medicine ;Spencer Wells the address on Surgery ; and Dr.

Priestly ofLondon,the address on Obstetrics .

A TESTIMON IAL. —Our attention has been cal led to a letter in the Toronto Mail

,

” written by

some over-z ealous friend ofDr. K inca id,ofPeter

boro, lauding that gentleman to th e skiesfor somem i raculous cure said to have been performed by

h im on th e wife ofthe writer. We can hardly

bel ieve it possibl e that Dr. Kincaid had any know

ledge of his friend’s intention or he would,both in

his own interest and for th e honor and dign ity of

th e profession to which he belongs,have dissuaded

h im from so open, unblushing, and doubtful acompliment.

OVAR IAN TUMOR IN A CH ILD — A case ofovarian tumor in a child twelve years ofage

,i s

reported by Dr. McG raw ofDetroi t, in the Toloo’oy oum ol

, (July No. ) The tumor was of rapidgrowth ; th e ch ild was undeveloped sexually, and

had never menstruated. She was tapped and

three gallons ofbloody serum removed,contain ing

some red blood corpuscles,but none of the u sual

granular corpuscles. The fluid rapidly re-accumu l

ated, and at the end of four weeks ovariotomy

was performed. The patient made a good recovery.

PROTEC TION AGAIN ST FL I ES—FO R DOC TOR’SHORS ES .

R — Linseed o i l, 3 KIJ

Carbol ic-acid crystals, 5 ii ;

Glycerine, 5 IS S

Dissolve the glycerine and add the oil. Apply

daily to legs,mane , tail, face , neck , and flanks ;

ous principle,at l eaving the

causing death . Various ot

this poisonous property,which is retained for

several months. I t i s absent from the fecal mat

ter ofheal thy subj ects.

Marshal MacMahon ofFrance comes of acal family ; his father and grandfather were

physicians.

PROF. DARL ING ofNew York, Dr. E.

and”

the fl ies are driven Off, much to the del ight of and Prof, Sayre, are in England at prth e horses.

LONDON HOS PITAL MED ICAL COLLEGE — Thefollowing is an extract from the announcement ofthe London Hospital Medical College.

Graduates ofany Canadian or American Univers ity or Medical College (on showing their Diplomas) will be admitted to six months

’ Dressershipand perpetual Surgical and medical Practice forth efee of ten guineas. Attendance on Lectureswil l befree

,but if Certificates are required th e

Courses must be paid for. Any number of Midw ifery cases may be attended.

THE ONTAR IO VETER INARY COLLEGE — We

need offer no apology for again alluding to th isu seful and valuable institu tion in our midst. There

is no greater friend ofth e human race than a goodfaith ful horse

,and when he becomes diseased or

disabled much may be done for h im by veterinary

skill. Through the kindness of Prof. Smith , thePrincipal

,we were shown through the school and

infirmary, and were much pleased with the interna l

arrangements. The'

school is thoroughly equippedwith models

,preparations

,and specimens for teach

ng purposes the dissect ing room is large andcommodious

,and th e infirmary i s neatly fi tted up

with numerous stal ls for sick animals. This college

is not only well known and highly priz ed in Can

ada,but i s also favourably known in the

States,and every year numbers of student

here to attend the course. Prof. Smith hasstaff associated with him in his work. We c

commend the school too highly.

THE

DAM IANA A FRAUD — Dr. Lunsford P. Yandel l

says Damiana is almost certainly an unm i ti

gated fraud . Three distinct vegetable products are

sold U nder the name. While i t may have produced

some very remarkable resul ts , these have been

brough t about,in al l probabil ity

,through the imagi

nation ofth e patien t. Could a medicine be dis

covered possessing the aphrod is iac power attribu ted

to damiana hal f ofth e arable land ofthe earthwould be d evoted to its cultivat ion and the supply

would then not equal the demand.

in the R ev. do Tire/ up ,benzoate ofl ith ium in theunl ike the other l ith ium

salts,i s readily soluble in water

,and th e benz oic

‘acid being converted into hippuric acid dimin

ofuric acid. Under the use

l ith ium,experience showed

ou t become milder and less

5 disappeared.

ALBUM INATE OFIRON — This remedy has proiarly good results in the hands of

cians i n anaemia and chlorosis. I t is

quite soluble and eas ily absorbed into the system,

and capable ofbeing borne on the weakest

stomach.

DRAINAGE IN ANASARC A.—At a late meeting of

Society ofLondon , Dr. Southey dein anasarca. I t

al l silver canulae,

eed les, to which

and conducted

su rprisingly large

in th is way by a

recen t lecturehe hadfrea syphil itic

had been

(1. He advised that cancerst growth s, wherever occurring, should

arsenic and iodide ofpotassium ihexternally, before proceeding to an

CANADA LANG ET. 29

PERS ONAL — Dr. John Wishart, ofTrinity Medi

cal School. Toronto, has successfully passed the

examination ofth e R oyal College of Surgeons,

England, and was duly admitted to the membership ofthat body. James Fulton

,M .D.,

Trinity

Medical College,has al so successfully passed h is

primary examination for the England.

THE DEATH of Prof. Crosby, ofBellevue Hos

pital Medical College, New York, on the roth

ul t., ofapoplexy, is mentioned in our New Yorkexchanges. Also the death of Dr. Sager

,of Detroit

,

formerly ofAnn Arbor Medical College.MORTAL ITY R ATE — Munich has at present the

highest mortal ity rate— being 42 per

Wife murder seems to be the latest form of insan ity in Canada.

The Senate ofth e London Universi ty has re

solved to admit women to degrees in medicine.

fistulas offirrirtira.HURON MED ICAL AS S OC IATION.

The th ird Quarterly Meeting ofthe Huron Medical Association for the year 1 8 7 7 was held inCl inton

,on J uly i 7 th.

The fol lowing members ofth e Association werepresen t z— Drs. McLean, Bethune, Worthington,Sloan , Holmes, Gibson , Young, Adams, Hanover,and Stewart. Dr. McLean

,Vice Presiden t

, oe

cup ied th e chair.

After the minutes ofthe previou s meeting wereread and approved, Dr. Stewar t introduced an

unmarried lady, 6 1 years ofage, affected with tru eprogressive bulbar paralysis. The disease com

menced eighteen months ago. The firs t symptom

noticed was sl igh t embarassment in speech. Her

present condition is as fol lows

( 1 ) There is complete paralysis of motion of th etongue. Common and special sensat ion are nor

mal . The tongue 13 sl ightly atrophied and is th e

seat of fibrillar contractions.

(2) The orbicularis oris and buccinator areboth affected. The lower j aw is drawn backwardsthere i s no lateral movement ofthe jaw.

(3) There is an excessive flow ofsal iva.(4) Speech is so affected that i t is impossible to

understand a word she says.

30

(5 ) Both the first and second acts ofdegluti tionare greatly interfered with . She has more d iffi cul tyin swallowing l iquids than solids.

food at times find their way into th e larnyx, giving

rise to severe attacks ofpartial asphyxia.(6) There is sl igh t loss of power in the s terno

mastoid and trapez ius.

( 7 ) When walking (especially if the eyes areclosed) she is apt to stagger.

(8 ) The mind is clear. She is very emotional .

She has been taking 1 - 1 00 ofa grain ofatropinetwice daily for a month. Which has had the eflect

ofdiminishing the flow of saliva considerably.Dr. Holmes Showed a woman , aged 39 , affected

wi th Splenic leucocythaemia. The Splenic tumor

firs t attracted her attention eighteen month s ago

since her last confinemen t which happened on

April 7 th , 1 87 7 . The tumor has been growing veryrapidly

.The spleen in this case i s not un iformly

enlarged. The increase in siz e is principally from

the lower border. Six specimens of blood exam

ined gave an average offrom 20— 30 white con

puscles to a field.

Dr.Gibson brought a specimen ofblood under

th e notice ofthe Society, which , under th e m icroscope

,presented the fol lowing characteristics

The proportion ofcorpuscles appeared to be twored to on e white. Afew ofthe white cells werelarge masses ofnucleated protoplasm having adiameter of not less than the 1— 1 000 ofan inch.

The patient from whom the blood was taken is a

woman,aged 42, mother oftwelve ch ildren . The

disease commenced about ten months ago ; th e

first symptom noticed was enlargement ofth e ab

domen.This has steadily increased and on ex

amination an enormous spleen is found occupying

fully half the abdominal cavity. The enlargedspleen extends from the 6th rib to th e ant. sup.

Spine ofthe il ium . Anteriorly above the umbili

cus,i t extends fully an inch and a half to the right

ofthe med ian line, but it scarcely reaches themedian l ine below the umbil icus . Both the in

guinal and axillary glands are enlarged in th is case.

Dr.Sloan read a vexy instructive paper on th e

Nature and Treatment ofDiphtheria.” This

paper will appear in the CANADA LANC ET.Dr

.Bethune

, ofWingham, was appointed to

read a paper at the next meeting ofth e Associat ion.

THE CANADA LANCET.

M IC H IGAN STATE BOARD OFHEALTH .

The regular quarterly meeting ofthis board wasParticles Of held at Lansing onJuly 10th.

Dr. Kedz ie made a short report on the chein icalexamination ofa specimen ofcheese bel ieved tohave caused sickness in several famil ies. He exam ined i tfor al l th e mineral poisons but foundnone. He concluded that the poison must be organie in its nature

,and that i t might come from

on e of three causes . I st,diseased milk 2nd

,

chemical decomposi tion of the cheese after i t wasmade ; and 3d , bad rennet. This poisoning by

cheese being so common , he was authoriz ed tovisi t various cheese factories and further investigatethe subj ect.

Dr. Kedz ie made a report on illuminating oils,

in which he stated that the l egislature had main

tained the standard flash test of 1 40° F. and had

provided a chill test for paraffine which will requirean improved qual ity ofo i l.Dr. Lyster, sent a communication in relation to

the small-pox in Detroit. The total number ofcases reported for the year ending

2 78, and the number ofdeaths 1 1 3 .

out th e fact that thisal lowed to prevail in

the present time the

measures to prevent

disease. He urgedfor vaccination throughout the state.

adopted the following :

Whereas,by mean s ofvaccination and re-vac

cination the people may secure complete immu

n i ty from small-pox,R esolved

,that al l local boards of health be ad

vised and requested to direct their health physi

e iaus to offer every year vaccinat ion with bovine

vaccine virus to every child not previously vac

cinated and to all other persons not vaccinated

with in five years,without cost to the vaccinated,

but at the general expense ofthe locality, as providedfor townships in section 1 736, Comp iledlaws 1 8 7 1 .

The board

on the subject ofpubl ic heal th.

https://www.forgottenbooks.com/join

THE C ANADA LANCET.

ANALYS IS OFSEVEN HUNDRED AND SEVENTYFOUR CAS ES O E SK IN D I S EAS E, treated at theDemil t Dispensary during the year 1 8 76 , with Practical Chemistcases and remarks on treatmen t, By L. D .

Bulkley,A.M .

,M .D.

, Physician to the SkinDepartment, Demilt Dispensary, New York, &C .

VIBURNUM PRUN IFOLIUM (Black Haw) , in thetreatment of the Diseases ofWomen , by Edward HW. J enks, M .D .

,Detroit Medical College.

FOURTH ANNUAL R EPOR Tlon THE STATE IN

EBR IATE ASYLUM, B inghampton , Ny , ’for 1 876,

Dr. D . H . Kitchen , Superi n tendent,

CAS E OFANEUR I SM OFTHE HEPATIC ARTERY,with Multiple Abscesses ofthe Liver

,by Drs.

R oss and Osler, McG ill Medical College, Mon

treal.

ABDOM INAL PREGNANC Y TREATED BY LAPAROTOMY

,by T. Gai llard Thomas

,M .D . New York.

R eprin t from volume 1,Gynecologi cal Tran sac

t ions 1 876.

A 'CAS E or TUBERC ULAR DROPSY OFTHE ABDOMEN, S IMULATING OVAR IAN TUMOR , by Theodore A. McG raw, M . D.

,Professor ofSurgery

Detro i t Medical College.

ON THE SURGICAL COMPL ICATIONS AND SEQUELSOFFEVERS. Lecture V. Toner Lecture. ByW il l iam W. Keen , M .D .

, ofPhiladelph ia.EPITHELIOMA PEN I S .

Maryland. R eprint from the Maryland MedicalJ ournal for August.

ON THE ANATOMICAL CAUS ES AND THE NATUREOFSYMPATHETIC OPHTHALM IA

,by Dr. Adolf

Al t, Toronto, late R esiden t and Assistant Surgeon to th e New York Ophthalmic and AuralInstitute.

FCANAD IAN MEDICAL AS SOC IATION — C ertificatesentitl ing the holder to a return ticket at reducedrates may be had on . appl ication to Dr. David

,

Montreal, or Dr. Zimmerman , Toronto.In addit ion to those already mentioned

,a paper

on The Economy ofPubl ic Sanitation,

” will beread by Dr. Playter

,editor of the S an i tary y our .

no]. Also an interesting p aper by Dr. Win. Cann iffof Toronto.

Operat ions by ChristopherJohn ston , M .D . , Prof. of Surgery, Universi ty of

Dr. C . A. Wood, of O ttawa, has beento the Chair of Chemistry in Bishop

’s College,

Montreal .

Dr. Lachapelle has been appointed Professor ofygiene , and Dr. Lamarche Professor ofHistologyand Microscopy

,in the Victoria School of Medi

cine and Surgery,Montreal .

A. B. Taylor, M .D.,of Allenford, to be an Asso«

ciate Coronerfor the County of Simcoe.M IS C ELLANEOUS .

A monument to Liebig was unveiled at Darmstadt, his native town , May 1 2th .

HUMAN MILx .—Chinese women sell their milk

for about fifty cents per pint. The milking is performed in publ ic to insure purity. I t is h ighly es~teemed as a nourish ing food for old people andconsumptives.

R EMOVAL O P THE KIDNEY.— Dr. Jessop ofLeeds, lately removed the left kidney from a childtwo years of age. The incision was similar to thatfor colotomy. A whip-cord ligature was placedaround the vessels and ureter and firmly tied. Thed iseased kidney weighed sixteen ounces. Thech ild was doing well at last reports.

stare, hammers and graffi ti .

I n Toronto. on th e 1 3 th ult., John HosteM .D.,

Eng , aged 44 years.

On the 8th ul t., J . F. Dewar, M .D.

Ed ., in the 43rd year

'

ofh is age.

On the r oth ult. , R . S. B. O ’Brian , Esq. M .D.

C .M . ofGrenvil l e, Que. to Sarah Eugenia,youngest daughter ofJohn McLean , Esq. Elora,

On the 1 4th ul t. , R . S . Moore, M .D ., ofMountVernon,Indiana

,to Bessi e H . , youngest daughter

ofthe late R ichard Will iams, Esq , Toronto.

In Toronto on the 1 8th ult ‘,N. R . Ol iv

M .D. ,ofLondon , to Mrs. Anne Smith, widow

the late David Smith,ofBrampton.

On the 28th ul t.,John McNaughton ,

M .D .,Newcastle, to Agnes, second daughter oftheCaptain Wilkinson , of Clarke.

THE CANADA LANCE'I‘.

HE ANADA ANGETA MONTHLY JOURNAL OF

MEDICAL AND SUR GICAL SCIENCE .

IBLE FLEXION IN FIBR OUS ADHES IONS .

BY JOHN GARDNER,M .D .

,HESPELER, ONT.

Thinking it ofinterest , I wil l take th e l iberty ofhistory ofmy own case with treatmen tAbout fourteen years ago I was em

ployed as a surveyor on the shores of Lake S u

perior. In my work I received a severe wound

close to the inner margin of the patella ofthe righ tkn ee entering th e join t

,from which th e synovial

fluid escaped in considerabl e quantity. I was so

situated that no medical aid could be procured,and merely bandaged i t up and made arrange

ments to start for home. Being many miles distant, i t was very painfu l during my j ourney,

'

and itwas evident that synovitis had set in . On arriv

cal man was sen tfor and diagHot poul tices were appl ied

the j oin t suppurating profusely

leg was kept perfectly straigh t

motion used whatever.‘

At my

were discontinu ed and other

The wound gradually healed

ofnine months I was able tot th e housefor several weeksmyself studied medicine

,and

in th e practice ofmy profesparts bu t my leg has

erfectlys tiff, I walked with a l imp. If my

contact with anyth ing,i t produced

the knee,and while riding in my

'

very inconvenient, n ot being able tothe s eat or on a chair

,owing to the

e that was produced on the back

I consulted many em inent surgeons in theUni ted States, some ofwhom thought by operating

,Some motion could be obtftined in the j oin t

,

others did not favour any in terference but being

myself des irous ofgaining the use of my l imb , retu rned hon‘

.e with that intent. After coming here,

I consulted Dr. Sylvester ofGal t, and he con

s idered an,

operation advisabl e. May 28th was

fixed upon as the day, and the Operation was pro

ceeded with as follows : I was placed on a table

and brough t thoroughly under th e influence ofchloroform by Dr. Ph il ips , I was then drawn wel ldown over the end ofth e table and a blo ck ofwood was placed under th e lower end ofth efemur to act as a fulcrum , th e thigh was well fixed

by assistants,and flexion was attempted. At firs t

i t was though t impossibl e to break down the ad

hes ion s that had formed . Dr. Sylvester informs

me that the amount of force required far exceeded

his expectations, but by cont inued pressure th eadhesions gradually gave way with audible crack

ing sounds,and th e leg was brough t down to

nearly righ t angles . I t was worked up and down

several times with ease. I was then placed in bed

and the knee encased in rubber tubing, and water

kept constantly running through , which kept th e

leg cool and prevented any inflammation . Mor

ph ia was administered , and very l ittle pain followed

,though th e parts were somewhat tender.

The leg was at fi rs t kept qu iet and straigh t. At

the end ofeigh t days I was again chloroformedand th e leg flexed but l i ttle force was required to

bring i t down . This tim e my leg was kept bent a t

nearly righ t angles,and tubing used as before.

After the bandages were removed, the leg gradual

ly straightened out. I now procured one ofTiemann

’

s anchylosis spl ints with a screw beh ind

the kn ee,and used this twice a day flexing the leg

to nearly a righ t angl e . I t i s now three month ss ince the operation

,and I am able to walk by the

aid ofa cane, and can flex my leg by muscular

action to an angle of45 degrees . I might here

add that the extensor muscles of the thigh were

very much atroph ied , but ar e gaining in -siz e and

strength . I am confiden t that in the course oft ime

,I wil l walk as wel l as ever.

I take this opportunity ofthanking those whoassisted in the ope rati on , and especially Dr. Syl~

vester,whose attention has been unti ring.

34 THE C ANADA LANCET.

CASE OF EMPYEMA .— TR EATMENT BY

CAR BOLATED IODINE LOTION .

BY J. FULTON , M.D. , ENG. , LOND.

In the number ofth is J ournal for October,1 8 7 5 , i s reported a case ofEmpyema occurring ina man aged 70 years, under my care, in which re

covery took place ; and I now have to report as imilar case occurring to a patient 23 years ofage,which resul ted in death . The fatal resul t

,how

ever,was not immediately due to empyema

,but

rather to the occurrence of an obstinate diarrhoea,with which th e case was complicated

,and which

resisted al l eflorts at treatment until the patient was

completely worn out by the long continued and

exhausti ve discharges from the bowels . The fol

lowing is a history of the caseWm . H ., act 23 ; born ofheal thy parents ; a

lather by trade mother,brothers and sisters al l

Ilving and healthy father died ofpneumon ia ; sayshe had gonorrhoea and chancroid general health

good up to the time ofattack no v isible sign s ofconsti tu tional syph il is sl ightly addicted to in tem

peranCe, tall , muscular, weigh t about 1 60 pounds

On or about th e 24th oflast May h e caught aSevere cold by lying on th e damp grass , and was

soon after seiz ed with pleuritic pain in the righ t

s ide. When I first saw h im he was suffering acutepain in th e righ t s ide, with d ifli culty of breathing,p ulse 1 20 , skin hot and dry, and symptoms indi

cating acute pleuri tis ofth e right's ide. I put him

under appropr iate treatment,and in a short time

he was rel ieved he breathed more easily, and in

afew days began to si t up. There was‘

evidence

ofeffusion in the pleural cavity on physical examination , but there was very l ittl e difficulty inbreathing, and the patient was able to assume theh orizont al position . There was no bulging of the

i ntercostal S paces, nor increase in the m easure

m ent of the righ t side of the chest. The symptoms

were not urgent, and I fully bel ieved the absorbents

would in a S hort time remove the fluid. With that

end in view I placed him upon iodide ofpotassiumcomb ined with diuretics

,and gave him occasional

d oses ofsulphate ofmagnesia,compound jalap

powder, &c. Blisters were also applied to the side

ofthe chest, and repeated at intervals. Under

th is treatment he seemed to improve for the firste ight or ten days, after wh ich the fluid increased,

and at the end ofa week or ten days th e chest was "

completely fil led . The patient was now obligedto remain in the uprigh t position . There was onlysl igh t bulging ofthe in tercostal spaces, and noappreciable increase in measurement of this side ofth e chest. The pulse was

,and had been for some

t ime from 96 to 1 00. At this j uncture I.

proposed

tapping the chest in order to get rid ofth e fluid,to which the patien t consented

,and desired to

have Dr. R ussel l ofth is city called to consul tation.

We accordingly met on the 1 8th of June,and aftera careful examination , he coincided with me in the

propriety ofparacentesis, which was done by meansofan aspirator and twenty ounces of lemoncolored serum was removed. This gave immediaterel ief, and the patien t improved for a few days ,but the fluid began to re-accumulate, and in about

eigh t days the chest was as'

full as before when I

again introduced th e asp irator needle,and to my

as tonishment withdrew fi fty ounces ofcreamylooking pus l Although every precaution was taken

to prevent i t, some air may have gained entrance

during the first operation. This Operation gave

great rel ief, and the patient was better and con

t inued so for abou t a week, during wh ich he was

able to get up and go ou t once for a drive. Thefluid

,however

,soon began to accumulate again ,

and caused h im more distress than before. Longbefore the chest was half ful l offluid, he complainedof pain and tenderness in the abdomen , chieflyin the epigastric and right hypochondriac regionso much so that I began tofear pointing throughthe diaphragm into the abdomen . I now decided

to employ drainage by the introduction ofan India;rubber tube in the chest. Dr. R ussell was again

called in consultat ion,and a tube was introduced

between the 8 th and 9th ribs below the angle of the

scapula,and allowed to remain . About th irty

ounces offoul smell ing pus escaped on the

introduction of the tube,and on the following day

about asintrodu

rubbercanula

THE CANADA LANCET.

was tied at the extremity, coiled up and retainedin sfla also by adhesive plaster after use.Through this tube th e pus was withdrawn and the

cavity washed ou t once every day with a lotioncontaining carbol ic acid and tincture ofiod iri e’finthe proportion of half an ounce ofeach to the pintofwarm water, a combination which had been sosuccessfully employed in th e former case. This

process was accompl ished by means ofa Davidson ’s syringe attached to the extremity ofth e tube.Under this treatment the formation ofpus rapidlydimin ished

, the lung began to expand , and greathopes were entertained ofhis speedy recovery.

The internal treatmen t consisted oftonics ofquinine, iron , and strychnin e, toge th er with syrupofthe iodide ofiron , cod-l iver oil, and sui table diet.

A few days after the tube was inserted, diarrhoea

set in , and continued with more or l ess severity

until h is death , which took place on the 1 3th ofAugust. The diarrhoea was preceded by tender

ness in the iliac regions , and was attended more

especially towards the .close with discharges ofpus,no doubt from extensive ulceration ofPeyer ’sglands . There was no hemorrhage. The dis:

charges from the bowels were also very offensive.

35

The condition ofthe chest after the introduction ofthe tube was

, on the whole, very satisfactory, and

butfor th is untoward compl ica tion the patientwould in al l probabil i ty have made a good re

One strange feature in the cas e was thecharacter ofth e ,

pulse, which varied very

duri ng th e whol e progress ofthe c asenever reach ing h igher than Tao— generally about

mere sk eleton before h isdeath . He

very much from dysuria,especially at

the d iarrhoea, and n ear the close of

e throat became extensively-u lcerated,voice . The . posterior surface oc e

fauces , and th e soft palate ,were

superficial greyish ulcers. Tincture

appl ied to the throat every second

C orrespondents.

THE MEDICAL PR OFESSION IN MICHI

chlorinatae in the interim,with marked benefit.

There was no post mor tom examination .

R EMARKS .— The plan oftreatment adopted in

th is cas e and in the one previously reported , has

many advan tages over the ordinary d rainage tube.

The tube is very easily introduced,and fi ts the

Open ing so tightly,during the first few days

,that

i t can be made entirely to exclude the air from th echest

,during a most critical period. This is

accomplish ed by allowing the pus to flow under

water, and after a sufficient quan ti ty has been re

moved, the extremity ofth e tube is t ied firmly,

coiled up , and retained in s i tu by strips ofadhesiveplaster.The whole of the pus need not

,and should

not be removed at once. If any S igns offain tness occur during the withdrawal ofth e fluid

,th e

tube can be tied and further removal discontinued

until th e next day , or next again. The tube be

comes loose in the chest, and air passes in by theside ofi t

,bu t not until th e lapse ofseveral days

,

when the greatest danger is passed. To th e extrem i ty ofthe tube a Davidson syringe* can beeasily attached

,and will be found ind ispensabje in

emptyi ng the chest ofcontained pus, or of pumping in fluid for th e purpose ofwashing out or disInfecting the cavity. In both these cases th is

apparatus w as used for removing the accumu

lated pus from day to day, and for thesubsequen t

washing out ofthe chest, with the carbolatediodine lotion .

To the Ed i tor or the CANADA LANC ET.SIR,-7—A few years ago quite a number ofmed i

cal men ofOntario were opposed to thebest medical law the world has ever seen , notwithstanding,perhaps

,some l it tle imperfections , which will be

remedied in due time. I bel ieve, however, th e

number of croakers at present is insign ificant, ye tthere are a few s til l l e ft to harp on the inj usticeo ffees, taxes and the general tyranny ofthe Council.I wish one or two of this class could be prevailed

A David son ’

s syringe can be made to take the place ofan aspirator by connecting an asp irator need le to i ts extre

m ity by a piece ofrubber tub ing . Ifthe syringe is fi lledw ith water before the need le i s in troduced and the d eliverytube kept und er water wh ile thefl uid is being d rawn off, noai r can possibly en ter.

36 THE CANADA LANGET.

upon to cross the borders into one of the States

where exists unrestr icted l iberty or free trade,in

al l matters medical . I am convinced the worst ofsuch croakers would be cured ofh is malady by atour into Mi chigan

,for example

,extending over

so short a time as four weeks. Should any ofthese sore-heads see fi t to act upon my suggestion ,I would recommend him to invi te Mr. Gordon

Brown ofth e G lobe to j oin h im on h is tour ofobservation .

Business, ofa non-professional character, demanded my attention recently in Michigan , where

I remained for a few months. I improved the

t ime as much as possible b y inquiring into the

state ofsociety,more especially as regards educa

tion and the profess ions . The common schoolsystem is not as good as ours was twenty years ago.

There is no regular s tandard ofqual ification forteachers. Any one may be a superintendent

,and

i s elected on town meeting day as are our Council

lors . Such superintendents,often ill iterate men

,

are the examiners ofcandidates for school certificates . The schpols are not open more than two

thirds of the year. Male teachers are employed inwinter and a female in summer. A poor high“

school they cal l a college, and from such places

issue forth yearly a host ofgraduates .”As a class

,the lawyers are ignorant and unre

fined,although the law requires an examination on

entering the profession— such examination beingl imited to a knowledge -oflaw

,t ime and education

being counted only— and i s > conducted in open

court by a circu i t j udge. I t is strange that this

should be the case when no such test is appl ied inmedicine. But if we look at home

,we shall find,

that amongst those who advocate free trade in medi

cine,not one has demanded free trade in law. Which

is the most valuabl e, a man’s property

,or his l ife P

As might be expected in a country enj oying

free trade in medical practice, the State is overrun by quacks

,both regular and irregular.

To one educated practitioner there are at least sixor seven who can lay no claim to being educated

.

I know of on e beautiful town oftwo thousand inhabi tants si tuated in the midst ofa rich agricul

tural country, and far from competition , which hassix quacks and only one educated doctor. This

ratio will stand good all over th e State. Many ofthese quacks have some kind ofdiploma obtainedi n Indiana o r elsewhere, and claim to be regulars,

and are loud in the denunciation ofquackery. Buafter al l they are very littl e above the ordinarquack in their education , their manners and theipractice . The larger number

,however

,have n

qual ifications for the profession further than the

braz en-facedn ess so essential to the successftcharlatan . Nothing

'

s trikes the Canadian morforcibly than the uncouthness

,general shabbiness an

the transparent lack of dignity and al l refinemerin the class of men , taken as a whole, addressed adoctor.” In Canada, a bod-carrier would b

ashamed to go down town in the garb in whioI have often seen these “ professional gen tleme

go about on the . streets .

The majority ofth ese men are oflow tasteand habits , and would disgrace any call ing. Gai

being their only motive power,they do not scrupl

to resort to any tr ick , or crime I may add,the

will promote their ends. Just fancy the anaauces. the six quacks above mentioned can dailbring to bear on th e l ife ofthe one educated an~

refined practit ioner with whom they are in comptition .

. This gentleman would give half a year’

i ncome, besides a l iberal annual tax

his tormentors. ‘ Think of that,ye

Ontario. All th e educated practitionerI came in contact would j oyfully

ofelevatin g the standard ofption they are unable to do so.

perience teaches us that most yothe nearest cut. I f the schools

long course they might as wellThe result is that the

graduates arefar bOntario. Nor can

laws se t a premiumtrain ing

,as is the

There isreference

enacted laws

process wi l l bfits will come

I t wil l take a

to the n ecess

THE CANADA LANCET.

son . As medical men , we should value the in

est imable privileges conferred upon us by the

State , and manifest our gratitude by, not only re

specting our special laws, bu t also by un iting to

make them more effectivefor th e accomplishmentofthe good and worthy ends for wh ich they were

that here and there a quack may be

foun d plying his vocation , is but a weak argumentagains t our laws . The man who so contravenes

the law is 'a law-breaker,and his vocation is thereby

o odious that bu tfew will follow his exAfew more short years and the quackever disappear.

The people,even more than medical men

,are

in terested in th is question . I t i s appal l ing to

th ink of the amount ofsuffering, physical and

ofMichigan alone . I wil l give

A medical friend asked me to

ride with him to see an elderly lady said to be su f

fering from ovarian tumor. We found her in bed.

She stated that she had suffered for eight years,from what the seven or eight physician s whom she

had consul ted in that time,called ovarian tumor.

She informed us she had been recently treated by

two physicians, one ofthem from a city some

fifteen m iles distan t. They t old her that an oper

ld be necessary— ofcourse they had noOperat ing

,that was a mere bl ind

,

and that in any even t her case was extremely

After l istening to th is h istory, we pro

take the dimensions ofthe tumor, but amost dil igent search failed to rev eal e ither i ts siz e

_

or location . In short,there was no tumor at all

The woman sufferedthe kidneys, and was

treatment. Wh o cantal sufferin g endured

5 she be

37

OBS ERVER.

October 1 3th, 1 8 7 7 .

(Saunagamma.

THE DOCTR INE OF CONTAGIUM VIVUMAND ITS APPLICATIONS TO MEDICINE .

*

munerative employment. The complimen t thuspaid to Canadian talent and Canadian institutions

,

was to me a source ofmuch pride and gratificat ion. Canadian practi tioners are to be found al lover the State

,and there is room for hundreds

more. Most ofthe medical talent ofth e State i sconcentrated in the larger centres of population

,

while pleasant villages and beautiful country places

are left the almost undisputed preserves oftheC harlatans .

GENTLEMEN ,— The notion that contagious diseases are produced by minute organisms has prevailed in a vague way from a remote age but it isonly with in the last twenty years— since th e publ ication ofPasteur’ s researches on fermentation andputrefact ion— that i t has assumed th e position ofa serious pathological doctrine. In the last decadestartl ing discoveries oforganisms in th e blood havegiven this doctrine the suppor t of actual observation ; and its appl ication as a guide in the trea tment of wounds by Professor Lister has made it asubj ect ofuniversal interest to medical practi tioners .The resemblance between a contagious fever and

the action ofyeast in fermen tation— or the actionofbacteria in decomposition— is in many points sostriking that i t i s diffi cul t to av oid the impressionthat th ere is some real analogy between them . If,for example

,we compare the action ofyeast wi th

the small-pox,this resemblance comes out very

distinctly,as the following experiment will show.

I fi l l ed two pint bottles , A and B with fresh saccharine urine

,and inserted a del icat e thermometer in

each . A was inoculated, with a minute quantity ofyeast

,but noth ing was added to 13. Both bo ttles

were then placed m a warm place in my room, ata temperature ofabou t 70° Fahr. In order to geta correct standard of temperature for comparison,I placed beside these a third bottl e, C , fil led withwater

,and inserted a del icate thermometer in i t.

All these bottl es were carefully swathed 1n cottonwadding

,for the purpose ofisolating their indiv id

ual temperatures,and to obviate as much as pos

sible th e disturb ing effects of the varying tempera*Address in Med icine by W . R oberts , M. D. , F . R . S .

Manchester, delivered at the British Med ical AssociationAugust 9th .

38 THEture ofth e room .For twelve hours no changetook place bu t at the end ofthis t ime A began toferment, and the thermometer marked a d istinctelevation of temperature. On the second day A

was in full fermentation,and its temperature was

2 7 deg. above B and c. This disturbance cont inued for five days

,the temperature ranging from

two to three degrees above the compan ion bottles.The d isturbance then subsided

,and the tempera

ture fel l to an equal i ty w1th B and c, and a con sidcrable sed iment, composed ofyeast

,settled at th e

bottom . In the meanwh i le B showed li ttle alteration but on th e sixth day it began toferment

,

the temperature went up,and for more than a week

i ts thermometer stood about two degrees above Aand c. Finally, the temperature in B decl ined , thedisturbance subsided, and the newly-formed yeastsettled to the bottom ofth e vessel.The fever in a bottle resembled small-pox in the

fol lowing po ints — A period ofincubation intervened between inoculation and the commencementofd isturbance ; then followed a period ofd isturbance accompanied by elevation of temperatureth is was succeeded by a subsidence ofthe d isturbance and a return to the normal state. Great multiplication ofthe infective material (or yeast) tookplace during the process , and after i ts conclusionthe l iqu id was protected from further infection w iththe same contagium . We l ikew ise notice that thecontagium offermentat ion

,l ike that of small-pox

,

may take effect either by d irect purposive inoculation“ or by fortu i tous infection through the atmosphere . In both cases the infective material hasthe power ofpreserving its activi ty for an indefini te period . The comparison fails in at least oneimportan t poin t— in the fermented urin e sugar isreplaced by alcohol and carbon ic acid

,but we are

not aware that any pronounced chemical changesoccur in the blood or tissues during the attack ofsmall-pox. I would

,mor eover

,carefully guard

myself against being supposed to suggest that theenhanced temperature in the fermenting urine is areal analogue of the preternatural heat offever.Let us d irect your attention to another example—a k ind ofpartial decomposition or fermentationwhich takes place i n boiled hay infusion when i t isinoculated wi th the B aci llus subtzlz

’

s. The B aez/la:

subt ilzs IS a very common bacterium,found i n veg

etable infusions and i n curdl ing milk. I hope youwill take note ofthis l ittl e organism

,for I shall

have to refer to it more than once in the course ofth is address . I took a flask containing hay-in fus ionwhich had been steril ised by boil ing

,and inocula

ted i t with a drop of fluid swarming with B aa /[us

subtzlzs After the lapse of twenty-four hours thepreviously transparen t infusion became turbid.

This turb idity increased,and on the second day a

fi lm or crust formed on the surface of the infus ion .

On the th ird and subsequent days,the crust broke

up, and fell in pieces to the bottom of the vessel.

CANADA LANC ET.

In about a fortnigh t the turbid ity passed away, andthe origional transparency ofthe in fusion was nowa sediment cons isting of the spores ofthe little organ ism at th e bottom of the flask. In this case,again , there was the same successi on ofevents— a

period ofincubation , followed by a period of disturban ce , succeeded by a period ofsubsidence,and, finally, restoration to the normal state. Therewas also great increase of the infective material andimmunity from further attack by the same contagi

The yeast-plant and the B aci llus sublz’

lz’

s may betaken as representatives ofa large class oforganisms , in regard to which we are only beginning toreal ise their vast importance in the economy ofNature and in the life ofman . They are as I shallpresently show, the essential agents in al lfermentation s

,decomposi tions

,and putrefact ions . We

may group them together,for the convenience of

description, under the general designation ofsapmp/zy tes

— a term intended to include,under one

heading,all the organisms associated with the de

composit ion and decay oforganic matter. Theyeast-plant and its allies, and all the numerousspecies and varieties ofbacteria

,belong to this

group. In siz e and form,they are among the

smallest and simplest of l iving things,but their vital

endowments are wonderful.

All the organ isms hitherto found associated withinfective inflamation s and contagious fever belongto the tribe ofbacteria, and we cannot advantageously enter on a study ofthat association without aknowledge ofthe origin and attributes ofthese organ isms. This brings us into a field of active controversy. I t has been alleged, as you know, on highauthority

,that these organisms

,under certain con

d ition s , depart entirely from the universal law ofgeneration

,which is expressed in the aphorism

0mm: k m 2711710, and that they may ari se spontan eously by a process of abiogenes is. I t 15 alsoalleged that these organ isms are not the actualagents of decomposit ion

,but are merely associated

with that process as secondary or accidental accompan imen ts, I propose to lay before you evidencethat both these allegations are unsustainable, andto prove that bacteria

,l ike other organisms, arise

from pre-existing parent gems,and in no other way,

and that they are the actual agents in all d ecomposition and putrefaction .

The first proposi tion I shall endeavour to establish is th is . that organ ic matter has no inherentpower of generat ing bacteria, and no inherentpower ofpass i ng into decomposition.

I have placed before you samples ofthree setsofpreparation, out ofa large number in my possession

,which serve to substantiate this proposi

t ion .

The first set consis ts oforganic l iqu ids and mixtures which have been rendered steril e byently prolonged application of the heat 0

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THE CANADA LANCET.

we cannot identify them as such under the microscope but Professor Tyndall has demonstratedthat air which is optically pure— that is

,air which

i s free from particles— has no fecundating power.I t is contended in some quarters that these par

t icles are n ot l iving germs ofany sort,but simply

particles ofalbum inoid matter in a state of changewhich , when they fall in to an organic l iquid, commun icate to i t the ir own molecular movement

,l ike

p articles ofa soluble ferment, and so produce decomposition, wh ich , in its turn , provides the condit ions necessary for the abiogenic generation ofbacteria. Fil tration through porous earthenwarefurnishes a complete answer to this theory for Ifound on trial that the soluble ferments passedwith ease through th e porous earthenware. If

,

therefore, th is theory were true, th e fil tered l iqu ids,ifalready commencing to be decomposed

,would

go on decomposing, and would develope bacteri aafter infi l tration but instead ofthat they remainedunchanged and barren . We are absolutely drivento the conclusion that these particles are l ivingterms : no o ther hypothes is squares in the leas td egree with the facts ofthe case.

>l< 96 96 a? "16

We now approach the more practical s ide of oursubj ect— that which concerns us as practi tioners ofmedicine and students ofpathology. I have al

ready d irected your attention to the analogy between the action ofan organiz ed ferment and acontagious fever. The analogy is probably real

,in

so far, at l east, that it l eads us to the inference thatcontagium , l i k e a ferment, i s someth ing that isal ive. We know of nothing in all our experiencethat exhibits the phenomena of growth and selfp ropagat ion except a thing possessed ofl ife.Thi s l iving someth ing can only be one oftwo

th ings ; either i t is an independ ent organism (aparasite) multiplying with in the body or on i ts surface, or i t is a morb id cell or mass of protoplasmdetached from the d iseased body and engrafted onthe healthy body. Possibly

,both these concep

t ion s may have their application in thep

explanation

ofd ifferent types ofinfective diseases. In regardto th e latter conception

,however— th e graft theory

—which has been so ably developed by my friendDr. R oss, I will only say that i t has not, as yet,em erged from the region of pure speculation . I tlacks an establ ished instance or prototype and itfai l s to accountfor th e long enduring dormant vital i ty so characteris tic of many contagia

,which

conforms so exactly with the persi stent latent vitali ty of seeds or spores, but which contrasts stronglywith the fugitive vital ity of detached protoplasm .

I f, then , th e doctrine of a contagium vivum betrue, we are almost forced to the conclusion that acon tagium cons ists (at l east, in the immense maj or i ty ofcases) of an independent organism or parasi te, and it is in this sense. alone that I shal l conS ider the doctrine.

I t is no part ofmy purpose,even if I had the

time,to give an account of the present state of

knowledge on this question in regard to every contagious disease. My object is to establish the doctrine as a true doctrine— to produce evidence thati t is undoubtedly true in regard to some infect iveinflammation s and some contagious fevers. In anargument of th is kind it is of capital importance toget hold ofan authentic instance

,because i t i s

more than probable— looking to the general analogy between them— that al l infective diseas es conform in some fash ion to on e fundamental type. Ifseptic bacteria are the cause of septicaemia— ifthespiril la are the cause ofrelapsing fever— ifthe B a»

ci llus ant/zracis i s the cause of splenic fever— the

inference is almost irresistible that other analogousorganisms are the cause -ofother infective inflammations and of other specific fevers.I shall confine my observations to the three

diseases j ust named — septicaem ia, relapsing fever,and splenic fever— merely remarking that , in rem

gard to vaccinia, small-pox, sheep-pox, d iphtheria,erysipelas

,and glanders

,th e virus of these has been

proved to cons ist ofm inute particles having the '

character ofmicrococci and that, in regard to

typhus,scarlet fever

,measles

,and the rest ofthe

contagious fevers , their connection with pathogenicorganisms is as yet a matter ofpure inference.S EP'r IczEMIA.

—We wil l first inquire how it standswi th this doctrine in regard to traumatic septicaemiaand pyaemia. You are al l aware that foul

,il l-con

d i tion ed wounds are attended with severe. oftenfatal , symptoms , consisting essentially of fever of aremittent type

,tending to run on the formation of

embol ic inflammation s and secondary abscesses.The notion that septicaemia is produced by bac

teria,and the rationale ofth e antiseptic treatment

wh1ch is based thereupon , is founded on thefollowe

ing series ofconsiderations .1 . I t is known that decomposing animal sub

stances— blood,muscle, and

.

pus— develope at anearly stage of the process a virulent poison

,which

,

when inj ected into the body ofan animal,produces

symptoms similar to those ofcl inical septicaemia.Th is poison is ev idently not i tsel f an organism i t

i s soluble,or at least

,d iffusible in water

,and it is

capable,by appropriate means, of being separated

from the decomposing liqu id and its contained organ isms . When thus isolated i t behaves l ike anyother chemical poison its effects are proportionate to the dose

,and it has not the least power of

self-multipl ication in the body. To this substanceDr. Burdon-Sanderson has given the appropriatename ofpyrogen . I t i s the only known substancewh ich produces a simple uncomplicated paroxysmof fever— begi nning with a rigor, followed by arise oftemperature, and ending, if the dose be nottoo large

,in defervescence and recovery.

2 . We know further, from the evidence I havelaid before ‘

you, that decomposition cannot take

1

,c

THE CANADA LAN0ET.

when a

examined under the microso swarm with organisms re

in all decomposing fluids .t becomes feverish

,and suf~

ymptom s wh ich we cal l sep

uce that what takes place inmuscl e in the laboratoryserous d ischarges and deadThese become infectedfrom the surrounding air

,o r from the water used

in the dress ings,with septic organi sms ; on thatfollows decompos i t ion and the production ofth e

septic poison,or pyrogen the poison is absorbed

in to the blood , and septicaem ia ensues .I t was the distinguished merit of Lister to per

meansifyouto therevent

of the sepof sept icaeaddress to

wh ich Lister attained th ispass j udgm ent on his practice

,

itted to express my bel ief thatwhich the treatmen t is founded isrobably differ less about the antiifwe took a broader view ofi tsare apt to confound the principlet with Lister’s method of carrying

inciple , i t appears tothe wound from the

they pass out ofi t before there 13 time for th e production ofthe septic poison

, or i f any be produced ,i t escapes so qu ickly that there is not enough ab

sorbed to provoke an appreciable toxic effect .Before we can unders tand the pathology of sep

ticaem ia we must have clear ideas on the relat ionof septic bacteria to our bod ies . We see in oldlaboratories that dead animal tissues

,when exposed

to o1dinary air or oo

rd ina1y water , i rivar iably breedseptic o 1gan ism s ; i n other words contact oftheseptic germ s with the dead tis sues n ever fails toproduce successful septic inoculation . But i t i squi te o therwise with th e same tissues when aliveand form ing part of our bodies . You cannot successfully inoculate the healthy tissues with septicbacteria . I t has been proved over and over againthat these organ isms , when separated from th e decompos ing med ium m which they grow

,can be 111

jected in quanti ty into the blood or t issues ofahealthy an imal

,or appl ied to a sore on i ts skin

,

without produc ing the least effect . The heal thyl iving tissues are an unsu itabl e soilfor them ,

theycannot grow in it ; 01

,to put i t in another way

,

ordinary sep tic bacteria are no t parasitic on thel iving tissues .Th is fact is offundamental importance in the

d iscussion ofth e pathology ofsepticaemia . Wehave a famil iar illustration ofi ts truth i n th e now

common practice ofsubcutaneous inj ection . Everytime you make a subcu taneous inj ect i on you inj ectsep tic g

orerms into the tissues . I had the curiosi tyto tes t

o

this poin t with the morphia solu tion usedfor th is purpose in the Manchester Infirmary. Iinj ected five drops ofthi s solution into four flask sofs teril ised beef-tea which had remained t1u

changed in my room for several months,tak ing

care to avoid any other source ofcontamination .

In forty-eigh t hours th ey were al l in fu ll putrefaction . But we know that no such effect followswhen similar inj ections are made in to the bodies ofour patien ts .I t seems also probabl e that septic organisms

enter constantly into our bodies with the air webreathe and the food we take they pass

,presuma

bly,l ike any oth er minute particles, th rough the

open mouths ofth e lymphat ics and lacteals,and

penetrate some distance 1nto these channels theycertainly come in contact wi th the accidental cuts

,

sores,and scratches which so often bedeck our

skins . Notwithstanding al l th is, our bodies do notdecompose ; indeed , i f ordinary septic organismscould breed in the l iving t issues as they do in thesame tissues when dead , an imal l ife would be impossible

,every l iving creature would infallibly

perish . How these organ isms are d isposed ofwhen they do enter our bodies acc idental ly

,as i t

were,in the various ways I have suggested

,we

cannot say ; we can only suppose that they mustspeedily perish

,for we find no traces ofthem in

the healthy blood and heal thy tissues . (a)Bearing in mind

,then

,that ordinary septic or

42

C 0 O 0

gam sms cannot breed 1n l i vi ng t i ssues , unless, atl east

,they are reduced to near the moribund state

bearing also in mind that th ere i s a sharp di stin ct ion to be drawn between th e sept ic poison and theorganisms which generate i t

,we are in a better po

s ition to consid er the course of events in a wound ,wh ich leads on to septicaemia and pyaemia . Whatprobably takes place is th is An unprotected woundreceives infection from the septic organisms ofthesurrounding med ia. I f the d ischarges are retainedin the s inuosities ofth e wound , decomposition ofthem sets in with production Of the septic poison .

This is absorbed into the blood , a toxic effect foll ows and septicaemia is establ ished . As th is effecti ncreases with the continuous absorp tion of thepo ison

,th e vital i ty ofthe system is progress ively

lowered,and especially th e vitali ty ofth e t issues

bordering the wound,which may be top ically affec ted by th e po ison wh ich percolates through them .

These tissues at l ength become moribund or d ieOutright the sep tic organisms then invade andbreed in them

,more septic poison is produced and

absorbed the toxaem ia becomes in tens e, embol iccentres ofinflammation and suppurat ion are formed and the end comes . In al l th is history there isno n ecess ity to assume, or even a probabili ty, thatsept ic organ isms invade

,or at least mul tiply in

,th e

blood .

death,but scarcely before that period .

In th e course oftraumatic septicaemia theresometimes occurs an event ofgreat importancewh ich imparts a new feature to the disease I meani nfectioeness , . How this arises is a matter Ofspecu lation . TO me it appears probable that

,under a

certain cond i tion ofoccurrence Ofconditions in andabout the wound

,a mod ification takes place in the

vi tal endowments Of the septic organism ,whereby

is acquires a parasit ic habit,which enables i t to

breed in tissues ofdegraded vitality or even in thehealthy tissues

,and in this way to produce the infective endemic pyaemia wh ich we sometimes wit

ness in the wards ofour large hospitalsd ‘ I shal l

develop th is idea more fully bye and bye.Before l eaving the subj ect ofsepticaemia, I may

al lude to the poss ibil i ty of wounds being infectedwith sept ic organ isms from within . As a rare occurrence

,I am incl ined to th ink that this is possible

,

and that i t may account for the occasional allegedi nfect ion Of protected wounds. From an Observation by C hauvea, i t may be inferred that sept ic organ ism s

,when inj ected d irectly into the blood

,are

able to surv ive for two or three days, althoughunable to breed there. i; I t is conceivable that oc

S uch a mod ification or variation m ight be correlatedw ith a m od ification oftheferm en t action , whereby a m ore

v iru len t septic po ison i s p rod uced . W ould n ot such a viewexp lain the sudd en i n ten s ificat ion Ofthe infecting v i rus

wh ich wasfound by C hauveau and D r. S anderson in the ir

experimen ts on infective inflammation

I C omptes Jt’ena

’us

,1873, p . 1092.

THE CANADA LANCET.

produce septic effects. Such a contingency,if i t

ever occur, must be very rare, and would not appreciably detract from . the value of the antisepticmode ofdress ing wounds .R ELAPS ING FEVER .

— In 1 8 7 2 , Dr. Obermeier,ofBerl in , discovered minute spiral organisms(spiri lla ) in the blood Of patients suffering from re

laps ing fever, Th is d iscovery has been fully confirmed by subsequen t observations . The organismsare found during the paroxysms th ey d isappear atthe crisis 5 and are absent during the apyrexialperiods .The draw ings represent the various appearances

presented by these l ittle parasites . They consistofsp iral fibril s ofthe most extreme tenuity

,vary

ing in length from two to six t imes the breadth ofa blood corpuscle. In the fresh state they moveabou t act ively in the blood . They have not beendetected in any Of the fluids or secretions ofthebody except the blood, nor in any other diseasethan relapsing fever. In form and botan ical characters they are almost ident ical wi th the Sp i roc/zaete

They may do 80

‘

at th e near approach Of p l icati l is ofEhrenberg, (Sp i r i llum ofDujardin ), a

spec ies ofbacteria found in dirty water and occas ionally in the mucus ofthe mouth . Cohn d es ignated the variety found in the blood S . Oberfnei r i ,in honour Ofi ts discoverer .In the beginning ofthe current year

,Dr . Hey

d en reich (e) ofSt. Petersburg, publ ished an elaborate monograph on th is subject

,wh ich

,I th ink

,

goes far to reconc ile the confl ict ing statements andOp in ions put forth by previous writers in regard to

the connection Of the spiri lla wi th relaps ing fever.I t is based on forty-s ix cases ; these cases werestudied with the most minute care 5 the blood wasexamined

,and the temperature Observed from two

to s ix times each day. Altogether,over a thousand

examinations ofthe blood were made .

R elapsing fever sti l l prevails extensively in certain d istricts ofGermany and R ussia

,bu t it i s al

most a forgotten disease in this country and probably the majority of those in th is room havenever seen a case . I t will

,therefore , not be am issif I remind my hearers

,and myself

,of its

features . I t is a con tagious ep idem ic feve

THE CANADA LANCET.

to day. One day they wereday they were scanty, and there again abundant 5 th ey evenhours ofthe same day 5 somealtogetherfor a time , and thent numbers a few hours later.variations the temperature t e

mained steadily high,or with only sligh t and

moderate osci l lations .been observed by presome to doubt

,whether

do with the virus ofrehappy idea suggested i tsel f toseems capable Ofexplai ning

them .

He found that when a l i ttle blood contain ingspirilla was abstracted from the patient and kept atthe ordinary temperature ofthe room

,the organ

isms l ived in i tfor several days 5 but if the bloodwas placed in an incubator an d maintained at thenormal temperature of the body, they died in fromtwelve to twenty hours

,and if the temperature was

kept up to fever heat ( 1 04 deg. F.) their l ife wasstil l shorter 5 they only surv ived from four to

This led him to the conjecture thatn paroxysm , not one, but several sucions ofspiri lla were born and diedal d isappearance at the crisis. Hein the u sual course , the broodseach other more or less

,the new

re the last surviaway. This exSpirilla found onof the same day.

have altogetherached maturity 5

appearance Of spirilla in the blood,al though at th e

time the patien t presented no other indicat ion ofwhat was abou t to happen .

If these observations are to be relied on— andthey appear to have been made with the mostscrupulous care —we are led to the conclus ion thatthe spiril la are the actual virus of relapsing fever.The same conclusion is also strongly indicated

by the results of inoculation experiments. R elapzsing fever i s easily communicated to a healthyperson by inoculation with th e blood ofa patien tsuffering from the disease. Experiments made inR ussia on individuals who voluntarily submittedthemselves to th is practice

,show that the blood i s

only infective during the paroxysms but not at th ecrises or during the apyrexial periods . None ofthe fluids or secretions ofthe body except the bloodare infective. All th is shows that the virus i s intimately associated with the spirilla

,and i s absent or

present in exactly the same circumstances as th elatter.The occasionally observed vanish in g and re-ap

pearance of the spiril la during the paroxysms,without a possibil ity Ofnew infection , seems to ind icate that when th e sp irilla disappear they leavebehind them someth ing in the nature ofseed or

spores,from which the new brood spring forth .

Ocular evidence ofsuch germs is , however, st il lwanting. Several Observers have noticed minuteparticles in the blood ofrelapsing fever wh ich migh tpassfor spores, and Heydenreich Observed thatsome Of th e spiril la had a dotted appearance. Buthitherto al l efforts to cult ivate the spores out ofthebody have failed

,and their power ofdeveloping

spores is more an inference than a demonstration .

SPLEN I C FEVER .-The fi rst trustworthy obser

vation Ofthe presence of organic forms in the infective disease was made in S pleni c fever. Thisformidable disorder attacks sheep , cows, andhorses

,and is not unfrequentl y fatal to man . In

1 85 5 , Pollender discovered minute stafl-shapedbacteria in the blood Of splenic fever. This discovery was confirmed in a very extensive series Ofresearches by Brauell, and has been corroboratedby Davaine and other inquirers in France .The bacterium ofsplen ic fever is a short, st raigh t,

motionless rod,about as long as the breadth ofa

blood-corpuscle,and so far as i s known , i t exists

in no other form in the l iving body. I t i s found ,besides the blood

,in th e S pleen , in the lymphatic

glands,and in some other t issues . That this

organ ism is the true virus of splen ic fever, has longbeen probable : and the labours Of Davaine , Boll inger

,Tiegel

,Klebs

,and

,most of all , of Koch ,

have removed th e last doubts on the subject. Thework done by Koch is not only valuable as atriumphan t demonstration of a d isputed pathological question

,but is noteworthy as a model of

patien t,ingenious

,and exact pathological re

search .

THE CANADA LANC ET.

We have come across an example ofscien tificprescience on the part of two dist inguished menwhich is worth notice. I t had been remarked byseveral observers that the contagium ofsplenicfever, as it existed in the blood, was comparativelyshort-l ived and fugitive

,bu t that, under some un

explained circumstances,the contagium was very

persisten t,and lurked for years in stables , and

other places where cattle were kept. Dr. BurdonSanderson

,writ ing in 1 8 74, inferred from the cir

cum stance that the organ isms ofspl en ic feversmust have two states ofexistence 5 namely, thatofth e perishable bacteria found in the blood andsome other more permanent form

,like seeds or

spores,in which they were capable ofsurviving for

an ind efinite period . In l ike manner,Professor

Cohn , guided by the botan ical characters oftherods found in the blood

,classed them in that group

Of bacteria name by h im B aci llus ; and as he hadobserved that al l th e B aci l li produced spores

,he

inferred that the B aci llus an tnr acis—for,so he

named th e bacterium ofsplen ic fever— would alsobe found to produce spores . These previsionswere proved by the researches of Koch to be perfectly exact.

a as at

The laws ofvariation seems to apply in a curiously exact manner to many ofthe phenomena ofcontagious diseases . One Ofthese laws is thetendency ofa variation

,once produced, to become

permanent and to be tran sm i tted ever after withperfect exactness from parent to Offspring 5 an

other and control l ing law i s th e tendency Of avariation

,after persisting a certain time

,to revert

once more (under altered cond i tion s) to the originaltype . The sporting Of th e n ectarine from thepeach is known to many hort iculturists . A peachtree, after producing thousands and thousands Of

p each-buds, will , as a rare event and at rare intervals, produce a bud and branch which ever afterbear only nectarines 5 and, conversely, a nectarineat long intervals

,and as a rare event, w il l produce

a branch wh ich bears only peaches ever after.Does not this remind us of the occasional apparentsporting ofd iph theria from scarlet fever ? Myfriend Dr. R ansome

,who has paid so much at

tention to the laws governing the spread ofepid emies

,relates the following instance — A general

outbreak ofscarle t fever occurred at a large publicschool . One ofth e masters who took the infect ion exh ib ited d iphtheri tic patches on th e throat.This patien t was sent to h is own home in Bowdon .

S ix days after his arrival,h is mother was attacked

,

not with scarlet fever,but w ith d ipther ia 5 though

there were no cases ofd iptheria at the time,neither at the school nor in Bowden . (a )

‘i. (a) C om plex cases ofm ingled scarletfever and d iph ther iaare sometim es seen . S im ilarly the peach - tree w il l occas ionally, among a m ult itude Oford i naryfru it, p rod uce one fru i tofwh ich on e-halfhas the p each character and the other half

ctar ine character . —DARW IN.

Take another i llustration : cholera suddenlybreaks out in some remote d istrict in India

,and

Spreads from that centre over half the globe. Inthree or four seasons

’

the epidemic dies away andceases al togeth er from among men . Afew yearslater i t reappears and spreads again

,and d isap

pears as before. Does not th is look as if thecholera virus were an Occasional sport from someInd ian saprophyte

,which by variation has acquired

a parasit ic habi t, and , having run through count

less generations, either d ies ou t or reverts again toits original type ? S imilarly

,typhoid fever migh t

be explained as due to a variation from some common saprophyte ofour stagnant pools or sewers

,

which,under certain cond i tions of its own sur

rounding,or certain conditions within the human

body,acqu ires a paras itic hab it. Having acquired

th is habit,i t becomes a contagious virus

,wh ich is

transmitted with its new habi t through a certainnumber ofgenerat ions 5 but finally

,these condi

tions ceasing, i t reverts again to its original nonparasitic type.In regard to some contagia, such as smal l-pox

an d scarlet fever,it m ight be said that the varia

tion was a very . rare one, but also a very permanent on e, with l ittl e or no tendency to reversion 5wh il e ot hers, l ike erysipelas and typho id fever,were frequen t sports

,w ith a more decided tendency

to reversion to the original type . In regard tosome pathogenic organisms

,i t m ight be assumed

that the parent type had d isappeared,and the

parasitic variety only remained - j ust as the wildparents Of many Ofour cultivated flowers and vegetables have d isappeared

,l eaving behind them only

their al tered descendants.

be called the “ Ep idem ic Constitu tion,hybrid forms and subqarieties oferupother fevers.I must not pursue “ th is vein further.

said enough to indicate that this conceables ns~ if i t does noth ing else- to haveideas about the origin and the spr

d iseases.In applying the doctrine ofpathogenic organ

isms— or patnop/zy tcs , as they m ight be termed— tothe explanat ion of the phenomena ofinfective diseases

,we must be on our guard against hard-and

fast l ines ofin terpretation . So farl imited knowledge n ow extends, theh i therto discovered al l belong to that

THE CANADA LANCET.

s septoocess

tly con

species.ful thana para

its host. A hundred examples might beEven differen t varieties or races ofthe

pecies have differen t and exclusive parasi tes .ld seem as ift h is n exus depended on somee shade— a nuance— something l ike anor a savour, or a colour, rather than on dif

Vaccin ia is confined to man,the horse

,

cow ; scarlet fever i s confined to man , andthe swine ; most of our specific diseaseslu tely confined to man . The human and

bovine small 'pox, al though so wonderfully sim ilar,are not in tercommunicable . I am

,therefore

,in

clined to believe that, in regard to specific contagia, we shall find more guiding analogies in parasi tism than in fermen tation . Our information atprese nt i s, however, so defective that i t is not wiseto enter into further speculations on th is subj ect.Gentlemen , I have brought my task to a con

clus ion . I bel ieve that the doctrine ofa contagiumvivum is establ ish ed on a sol id foundation 5 andthat the principl e i t involves

,i f firmly grasped in

capable hands, will prove a powerful instrument offuture discoveries . And let no man doubt thatsuch d iscoveries wil l l ead to incalculable benefi tsto the human race : our business in l ife i s to dobattle with disease, and we may rest assured thatthe more we know ofour enemy the more successfully we shal l be able to combat him — Med ical

P ress and

SUR GER YFASTAND PR ESENT. (a)

BY T. S PENC ER WELLS ,The author commenced his address by tracing

He con tended that thein th e period mentionedny other art or science 5had been , and consider

ght be further carried on ,

subj ect ofanaes thesia and

that in 1 8 7 2 he made known his Opin ion that al lth e advantages ofanaesthesia

,w ith fewer draw

backs , could be obtained by th e use Ofbichlorideof methylin e or ch loromethyl than by any otherknown anaesthetic. I t was the result of an experience Of five years and of 3 50 serious operations .The experience ofth e five succeeding years

,with

more than 600 addi tional cases ofovariotomy,and

many other cases Of surgical operation,had ful ly

confirmed him in that bel ief. Perhaps they werehardly aware how much the publ ic expected fromthem in th is matter. Deaths from chloroformwere alarmingly frequent

,yet no substitutefor i t

had found universal or even general acceptance inth is country 5 and he was not speaking too stronglyif he said i t was the duty of the Association atonce, withou t any unnecessary delay, to satisfy thepublic that al l that was possible was being done todiscover the means by which anaesthesia

,effectual

now, migh t be rendered safefor th e future. Acertain section of the community

,well meaning i t

might be , but led astray by thoughtless enthusiastsor self-interested i tineran t lecturers

,vehemently

asserted that if medical men were to perfect themselves in these or in other modes ofsaving humanl ife or lessen ing human suffering

,they must only

do so by practice upon the human subject 5 theymust n ot, as a surgeon or a physiologist, take th el ife of a dog or a cat, a rabbit or a sheep, a pigeonor a frog, for any scient ific purpose, or with theobject ofbenefitting the human race. Anybodymight slaughter oxen and sheep by thousands forhuman food in any way he pleased

,oysters migh t

be eaten al ive— the pheasant or the partridge,thefox or the deer might be expressely reared to sup

ply the sportsman with exercise Or the amusementofkill ing ; in a word, the lower animals migh t bedevoted to the u se ofman for any purpose thatwas not scientific. But if a surgeon experimentallysacrificed half a doz en dogs or rabbits in the hope ofimproving some Operation which m ight prevent theloss ofhuman l ife or l essen human suffering, h ewas branded as inhuman

,and barely escaped th e

supervision ofth e pol ice. Possibly some Of thosebenevolent individuals would voluntarily offer upthemselves to the committee on transfusion

,in the

hope ofperfecting the practice . Until they did so,

they would perhaps be a l ittle less clamorous if afew sheep or rabbits were used in the cause ofhu~manity. With regard to splenotomy

, pancreotomy,and nephrotomy

,accident had proved that the

spleen , or the pancreas, or a kidney migh t be lostwithout great inj ury to the human being. Surgeonshad removed wounded pancreas and enlargedspleens

,and a diseased kidney had been extirpated

on two occasion s at least, but the operative proceed ings were still imperfect. Were surgeons tobe allowed to excise the S pleen or a kidney Of adog or a rat , or would z ealous members Ofsomeanti~vivisection society enrol themselves as candi

THE CANADA LANCET.

dates for that immortal ity which was gained byanyone who immolated himself upon the altar ofscience ? I t would be false modesty if he werenot to say boldly before the Association that hewas proud Ofthe share which Bri tish surgeons hadhad , and of the share which he himself had had inplacing ovariotomy upon the roll of successfulsurgical operations. Great leaders among them

,

Simpson and Syme,Stromeyer and Bil lroth

,Vel

peau and Nelatou,had shown

‘a generous appreciation ofthe ir work. And could they imagine agreater pleasure to a surgeon than to hear thepres ident ofthe Medical and Chirurgical Societyspeak of h is improvements in the operation ofovariotomy as “ one of the greatest achievementsofsurgery in th is century

,and the influence for

good extended through every department ofoperative surgery ? While at the same society in1 850 , Lawrence had asked whether th is Operation“ can be encouraged or continued wi thout dangerto th e character Of th e profess ion ?” less than aquarter ofa century after that denunciation LordSelborne publ icly stated the result Of a cal culat ion

,

that by h is (Mr. Wells’s ) first 500 Operations h e

had added something l ike years to thel ives ofEuropean women .

What number of operat ions had been done byother surgeons h e knew not

,but supposing that

the same probabil ity of the duration ofl ife appl iedto the women who have recovered from operat ionshe had done since the results ofhis 500 cases werepubl ished in 1 87 2 , the gain would be aboutyears, and this by one surgeon alone, and by anoperation which only th irty years ago was denounced as so fearful “ in its nature

,Often so

immediately fatal in i ts results,

” that,whenever

performed,“ a fundamental principle of medical

morali ty is outraged .

” When German princespractise surgery, and a brother ofan English Earl,a Cabinet Minister, was met with as a practisingphysician, they might th ink less ofthe admissionOf members Oftheir profession into royal andnoble famil ies, and look with more hope for recogu ltion by the Government Ofservi ces rendered bymedicine and surgery to the nation . They wouldnot then have to notice anything so dishearteningto a learned profession as the fact

,that while for

the affair of Magdala Lord Napier was honouredby a t itle and rewarded with a pension

,the ex

tended average durat ion Ofl ife of th e whole population , and its actual increase, due to san itary andmed ical science, and far exceed ing in importancethe annexation of a province

,or even ofa king

dom , had earned for S imon the barren righ t, sharedby many less honourably known men

,of putting

the magic letters C .B . after h is name,and Wil l iam The R enewal of Prescriptions in Germany has

Farr st il l remained without any mark Of nat ional recently been forbidden by law,except on the

gratitude . Why should a baronetcy be the h ighest order ofthe phys ician originating the p rescr1pt1on ,t itular d istinction conferred upon members ofthe ir whenever i t shall contain powerful med icm es

, suchprofession Was Jenner or Paget less worthy ofas drastics

,emmenagogues

, emet1cs or op 1ates.

a l ife-peerage than anyone Of the eminent men whonow s i t on the bench ofbishops — or any ofthelawyers

,soldiers

,or sailors who had been rewarded

by hereditary peerage ? None of their leaders hadtime for electioneer

’

i ng or the turmoil ofpartystruggles in the House Of Commons 5 whereasmany ofthem were well fi tted for the more diguified position, and would be qu ite able to devotetheir t ime and energy to sanitary legislation in theSenate.If,in the 40 years since the Association was

founded,the great progress wh ich he had so has

ti ly and imperfectly endeavoured to review hadbeen made

,what might they n o t augur for it in

years to come ? The Association had its earlystruggles

,and had passed through them . The

history ofthe past and the study ofth e present,al ike helped them to look forward with hope andtrust to the future . He further urged the importance, or rather the absolu te necess ity, that the surgeons ofthe fu ture must be educated gentlemen 5that schemes ofeducat ion should be so ordered asto bring into the profession

,as far as possible

young men who had had the advantage of thehighest general culture to be Obtained by anyEngl ish education . Until this was secured theflower of the University youth would stil l choosethe church or the bar, the army or the navy, orsome branch of the C ivil Service ofthe State,where they at once took an enviable social positionas members ofan honourable profession

,and

where a successful career might lead to a seat inthe House ofLords, to the pensions and tithesfreely granted to the fortunate soldier or sailor

,

and more sparingly, to the meri torious C ivil servant Ofthe Crown . I t was rather surprising thatwithout any of those inducements , and in spite ofthe taint oftrade forced upon the profess ion bythe powers Ofthe Apothecaries ’ Company, and itscont inued alliance with their colleges and universi ties

,they stil l had abundant evi dence Of a rapid

rise ofthe profession in the social scale — Med .

P ress 69° C in ular .

THE LOC AL TREATMENT OFPsp R IAsrs , as recommended by Ausp itz (Al/g . M ea

'. C en t-fi g ) , d iffers

decidedly from the scrap ing recommended by theyj un ior Hebra and Bard enhever, for their plan isalmost always followed by relapses . The best reSults , he claims, have been Obtained from briskfricti ons with fine sand

,fol lowed by the local appli

cation of liq. ferri sesqu ichlor.

https://www.forgottenbooks.com/join

THE CANADA LANCET.

duction . An interv iew with the former phys icianand some look ing up of the subj ect impaired myconfiden ce in the diagnos is

,and began to make

m e fancy i t m ight be a fibro id polypus . I supposemany Ofus experi’ence sim i lar doubts in cases whereabsolu te certainty does not exist. Dr. F i tz kindlysaw her w i th me next day, and the rectum havingbeen thoroughly evacuated and a thorough examination made poss ible, a correct diagnosis waseas ily made.The patient was etheriz ed by Dr. W. A , Dunn,

and hav ing been placed upon her back'

th e firstm ethod was followed. The u terus was graspedfirmly by the hand

,th e vagina put upon the stretch

and steady pressure was mad e obl iquely upwardsand backwards in the axis ofthe pelvis

,lateral com

pression be ing made at the same time , with theendto reduce firs t the part Of the u terus inverted last.'

After ten m inutes’ continuous effort without apparently effecting anyth ing

,my hand became fatigued

and Dr. F i tz took hold . After th e exp i ratipn ofanother ten minutes the organ began to diminishin siz e and to return to its n ormal posit ion

,so that

when I again resumed the completion was a matter ofon ly afew moments. There was none ofthesnap of spontaneous return mentioned in the booksin th is case ; th e fingers were not only obl iged tofollow the fundus and push i t into place

,but to re

m ain in utero unti l the cervix began to contract. Extern al manipulation hastened this

,and wi thin half

an hour the organ was fairly contracted . Therewas very sl ight haemorrhage during the Operation

,

none ofany consequence after. The patien t waskept in bed for a week and then allowed to si t up .

Noth ing important occurred afterward ; there wasa lame back and a sense of soreness in the righti l iac region , but no pain or l eucorrhoea. Therealso remained for some time more or l ess vertigo

,

referable to excessive loss ofblood,which t ime and

ton ic treatment wholly removed — B oston M ed ical

y ournal .

DEATH FR OM CHLOR OFOR M AVER TEDBY THE INHALATION OF NITR ITE

OF AMYL.

We have received from a physician, (B r i t. M ed .

j ournal) , the following interesting reportfor publ ic at ion . On th e 29th instant, I was asked by aprofessional friend to administer chloroform to apat ient Of h is

,from whom he was about to remove

afatty tumour,S ituated in the left lumbar region .

The patient in quest ion was about forty-nine yearsofage , married , the mother Of several ch ildren ,

ofth in spare hab i t bu t otherwise in good health .

She was nervous,and apprehensive ofth e result,

entreating me not to give her too much chloroform . Hav ing previously exam ined the heart andfound al l th e sounds normal

,I gave her about '

two

teaspoonfuls ofbrandy undiluted 5 and after waiting a few m inutes

,and placing her in the recum

bent posture,I commenced the adminis trat ion .

The chloroform I ,used was Duncan and Flockhart’s

,upon the puri ty ofwh ich we can always de

pend. I poured a measured drachm upon a pieceof l int

,enveloped in a towel . I held i t some l ittle

di stance from her mouth and nose , and let her inhale slowly. My friend n oted her pulse, whilst Icarefully watched the respiration . The first dosedid not produce any effect, and I then used an

other drachm,which soon caused a good deal of

exc itement,incoherent talking

,and struggling

the patient striving several t imes to snatch the inhaler from my hand . This gradually subsided ,and she appeared to be pass ing in to the th ird stageofanaesthes ia when she made an abortive attemptto vom i t , raised h er h ead from th e pillow,

and , to

my friend’s great alarm

,the pulse fl ickered and

stopped al together 5 she gave a gasp 5 foam gathered '

on'

her l ips ; her jaw became rigid ; and to .

all

appearance she was dead. I immed iately W 1th

drew the chloroform 5 myfriend dashed some coldwater on her face and pulled her tongue forward,wh i lst I commenced artificial respiration , afterMarshal Hall ’s method

,bu t without success . We

then poured some ni trite of amyl on l int , and heldi t to her nostrils . In such emergencies, i t i s 1mpossible to judge the fligh t oft ime correctly 5 butI should say in ten seconds there was a flushing ofthe face

,the pulse was again fel t, and, to our great

j oy,the all-important

(function of respiration was

again restored 5 the woman being rescued ap

parently from the very articl e ofdeath . After atime

,the anaesthesia seeming tolerably profound,

my friend proceeded to remove th e tumour, wh1chhe did in a rapid and skilful manner, wh ilst , as thepatient grew restless

,I gave an occasional whiffof

chloroform . I t proved to be an ordinary fattytumour. Only one smal l vessel required to bel igatured . The wound has since healed rap i dly,and the patient has made a good recovery. In

looking at the order Of symptoms , I cannot helpforming the opin ion that

,had it not been for the

n itri te Ofamyl , th is poor patient would assuredlyhave died. I have never seen , either in surg1cal

or obstetrical practice,any one in such imm inen t

peril . I am thankful to say I have never Wi tnessed a case ofdeath from chloroform 5 but, from theaccounts publ ished in the medical j ournals , both Iand vmy friend inferred that, in the presen t o

i n stance,

there was syncope arising from paralys1s of theheart

,and that this was met by the n itr ite ofamyl ,

which,i n accordance with i ts physiological effects,

gave a direct fillip to the arrested circulat1on .

M ILK TAVERNS .-The establishm en t pfmilk

taverns is n ow strenuously advocated i n manyplaces

,as supp lemen tary to the temperance move

ment.

THE CANADA LANCET.

long, had been sewed 5the l imb and spl int

,

below the patella, served to secure th ee spl in t and to hold the ends ofth eers down against the broken bone

.The

cloth being passed around,

th e pulleyupon, the fragments were held together

i th comfort to th eofcloth was then

The smooth cloth,passing over

ne, caused no pain and prevented

1rculat1on was not in terfered with,

trOl over the fragments was main

treated three cases in th is way, withts and W i th comfort to the patients

.

ed.

wi th

ases and

POPLITEAL ANEUR ISM CUR ED BY THEAPPLICATION OF ESMAR CH ’S BAND

AGEFO R FIFTY MINUTES .

Michael M . aged th irty-s ix,a grocer, was

admitted into Mr. Tyrrell’

s ward at the Mater'

Eisericord iae,Dubl in

,on the 2o th of April , w ith an

aneurism ofthe l eft popl iteal artery . He statedthat up to the preceding March he had enj oyedgood health , except for a Short time in September,1 8 7 2 . when h e had a sl igh t attack ofrheumatism .

He had been in America for a year,and while

there was very intemperate.On the r o th ofMarch

,when kneeling

,he was

seiz ed wi th a most violen t stinging pain in the

back ofh is left knee. He stood up at once,and

the pain ceased until h e went to bed,when i t re

turned wi th increased violence . The pain cont inned during th e nigh t

, to disappear again in themorn ing. On examination he noticed a smal lhard ish lump in h is left arm

,but d id no t feel i t

th robbing. For about a month after this h e con

tinned qu ite well , except for a dull pain in the leftarm wh ich attacked him on and off. IOn the 8th ofApril

,as he was returning home

from a long walk,he was again attacked with a

most v iolent r acking pain , and the lump, wh ichhad up to th is date been S lowly increasing in‘ siz e, .

now increased rapidly,and commenced to throb .

He painted i t w ith tincture ofi odine, and restedfor some days 5 but, not finding h imself gettingbetter

,he sentfor Dr. White . That gentleman , at

Once recogniz ing the nature ofthe disease , senth im to Mr. Tyrrell . There was no h istory ofsyph il is .On examination

,a large pulsating tumour was

fel t an d seen in the left popliteal space, measuringfive inches from above downwards

,and five inches

and a half from side to side. I t was soft,and a

slight bru i t was audible with the stethoscope overit. The

,superficial veins ofthe l eg were swoll en ,

and the whole l imb was sl ightly o edematous..

Nei ther the anterior nor the posterior tibial arteriescould be fel t on the left side but were palpable onth e right . The circumference ofth e left kneeimmed iately above the patel la was fourteen inches,.on the right s ide twelve inches and a hal f ; half aninch below the patella on l eft S ide fifteen inches,.on th e righ t s ide eleven inches . The tumour wasprincipally in the inferior port ion Of the popl itealspace. The heart sounds were normal . He re

quired large doses of morph ia to give case fromthe violen t pains

,shooting from the toes to th e

h ip,wh ich cameon at n igh t . He was ordered to

remain in bed,and to take immediately a ful l

sal in e cathartic'

draugh t. He was put on a re

stricted meat d iet , got very l ittle to drink , and wasallowed ice and oranges to allay h is thirs t . Hehad a subcutaneous inj ection of morph ia at

n ight.

50 THE CANADA LANCET.

On the 24th of Apri l Mr. Tyrell appl ied Esmarch ’s bandage. Commencing at the toes

,the

bandage was wound tightly round the l imb as highas the tumour

,then l ightly over it, and again up

the th igh . The elastic tourniquet was also put on .

The patient complained of considerable painwhile the bandage remained on ,

but it was not S Osevere as to cal l for the use of an anaestheti c. Mr .Tyrrel l allowed the bandage to remain on fiftyminutes. On i ts removal al l pain ceased. Thetumour had sensibly diminished in siz e

,was quite

hard and globular,and had a very sl ight pulsation .

Digital compression was kept up for two hours .When examined at th e expiration of that t ime thetumour was found absolutely pul seless. AS amatter of precaution a compressor was appl iedover the femoral artery at the pubes, and the pat ien t was directed to keep i t moderately t ight.After the elastic bandage was taken Off, th e legand thigh were enveloped in a flannel bandageand elevated on pillows .

On the 25th April, the patient, having slep t al l,night

,said he was free from pain

,but complained

ofnumbness in the toes and foot. The articulararteries around the knee could be both seen andfel t to pulsate . In th e evening pulsation was fel tin the anterior tibial on the dorsum Of the foot.The tumour fel t very sol id 5 no trace ofpulsat ion .

Next day the patient was better in every respect 5th e oedema Of the leg was nearly gone

,and sensa

tion was normal in the foot . He slept well, andth e tumour was apparently smaller. On May r st

the patien t got up and dressed himself,and was

anxious to be allowed to walk about,but Mr.

Tyrrell would not allow this, as he thought i t moreprudent to rest the leg for some time longer. O r

dered a pair ofcrutches. On May 2d the patientwent home — Lancet, June 30 , 1 8 7 7 .

R ECOVER Y FR OM A WOUND PER FORATING THE STOMACH.

In theAer z tlic/zes [ n telligenz —B latt for December26

,1 876 , Dr. Brand , ofFussen , records the following

case. He was sent for on the 2 2nd OfJuly to seea boy

,aged five years

,who was said to have fallen

down , and received a wound in the abdomen , fromwhich something was hanging out. On arrival hefound that the boy had fallen from a table to thefloor wi th an earthen pot dc clcambre, and had cuth imself with one of the pieces of the broken vessel .His father drew the broken piece from the wound.

This was soon after supper,and his stomach must

have been pretty ful l at the time. On examination ,a somewhat jagged wound was found on the leftside of the abdomen in the lower part of theep igastric region

,on e and a quarter inches from

the median l ine. The wound i tsel f was almost even arrest the febril e exacerbation .

vertical,and about one and three-quarter inches

long. Some great omentum protruded from it.The boy vomited whilst the necessary questionswere asked , and part ofthe stomach , about th esiz e Of an apple— about two and three-quarterinches in diameter— was gradually forced out ofthe wo

'

und. In this there was a “ solution of contiuity

”ofthree—fifths ofan inch in length , which

al lowed food to escape from the stomach . Duringthe vomiting

,Dr. Brand kept up gentle pressure

on the abdominal walls, then carefully cleansed theextruded part, l igatured a small sp irting artery,united the stomach wound— peritoneum to periton eum— with a sti tch , the end ofwhich , with th el igatures

,he brought out at the external wound.

Two su tures, passing through the peritoneum,closed the external wound

,after careful cleans ing.

Strips of plaster were also applied. The very pat ient l i ttle sufferer was much exhausted. His skinwas cool ; his pulse 1 08 . He was put to bed

,

iced compresses applied to the wound,smal l doses

OfOp ium ordered , and ice to be sucked to rel ievethirs t. Next day his pulse was 9 2 ; temperaturealmost normal . He felt pretty comfortable . Therewas slight redness round th e wound. In the nextfew days there was some abdominal tenderness

,

but not distension : and gradually, with very moderate febrile symptoms

,a circumscribed abscess

formed from which, after removal of the stitches,

on the sixth day,a considerable quantity of good

thick pus escaped. At the same time gentle traction removed the suture and ligature belonging toth e stomach-wound. All bad symptoms vanishedfrom this date

,though some pus was discharged

until the 9th ofAugust, when the external woundcicatriz ed. On August z r st the boy was broughtagain with a swelling in the old s ite. Pressurecaused a smal l quant ity of pus and a caraze/ayseed to escape from the dis tended cicatrix . Threedays afterwards

,the wound again healed. After

a year,the boy was seen again in good health , not

suffering the least from the accident , and it appeared that the stomach was firm ly attached to theabdom inal wall. The sligh t nature of the symptomsal l through is very remarkable — London M edical

SAL IC INE EOR C H ILLs.— Dr. Thompson reports,

in B r i ti sh M ed ical y our nal,a number ofcases

showing the superior effacacy of salicine in thetreatment of intermittents. Cases wherein quininehad utterly failed were promptly relieved with thisagent. He used large doses

,grs . xxx every two

hours . Usually the fourth dose was sufli cien t tobreak up the chain ofmorbid action, after whichafew doses at regular intervals completed the cure.I t may be given when the chill i s on , and wi ll

THE CANADA LANCET.

ABS C ES S or THE L1VER .— In th e P racti tioner for

the current month , there IS a good practical paon this subj ect, by Sir J .Fayrer, K .C.S.I .

,M .

in which the author draws atten tion to the insid ious manner in which these abscesses are often developed . As a rule

,th e early symptoms of suppu

ration are those ofcongestion,with bulging of the

understood, that a man may have an abscess ofthe l iver, which is not evacuated , and yet recoverafter its removal by absorp tion

, or by i ts remainingin a state ofquiescence for the remainder ofh isl ifeWith regard to the vexed question ofthe priori ty

ofhepatic abscess , or of dysentery, 1n those caseswhere these affections occur together

,Sir ] .Fayrer

is incl ined to regard them as independent ofeachother, though often co e- xisten t, and due to thesame cl imatic causes .As to the treatmen t of l iver abscess

,th e author

advises at the outset local deplet ion by leeches onthe side , when the symptoms are acu te, the paingreat, and the fever high . Also free purgation bymercurials, sal ines , and ipecacuanha, with hotfomentations, res t, and a light diet. When i t is obvious that pus is formed

,th e evacuation ofthe

matte r must be favoured by such channels as mayseem most favourable. '

1 he strength must be supported , and irritation al layed ; and when the abscess i s suffi ciently n ear the surface to j usti fy ex

evacua ted.

fiepnrta offiflt ittiefi.CANADA MEDICAL ASSOCIATION

.

F IRST DAY’ S PROC EED INGS .

tenth annual meeting ofth is Associationon th e 1 2 th and 1 3 th ul t. , in Montreal

5 1

Thefollowing extracts are taken chieflyfrom the Mon

treal G azette.

troi t, and Dr. Adams, and were invited among

others to seats on th e platform.

Dr. DAV ID, the Secretary, read the minutes ofthe las t annual meeting

,which were approved.

A large number of n ew members were duly

proposed , and admitted as members ofth e Association .

Letters ofapology were read from absent members of the Association .

The Presiden t then read th e annual addresswhich showed deep research and a close acquain

tance with the subj ects treated upon .

* After acknowledging tersely the compliment paid him incall ing him to pres ide over th e convention

,he

said, that much as had been done by the Association

,since its formation in Quebec ten years ago ,

al l the advantages hopedfor by i ts founders hadnot yet been realiz ed

,although suffi cien t had been

done to show every member that a greater degreeof energy pervading and agitating the whole wouldhave led to the achievement ofa greater degree ofsuccess. Notwithstanding diffi cul ti es arising fromsocial and geographical conditions

,much good

had been done . I t had been the custom at theopening addresses before Societ ies i n Europenotably so in Great Britain— to take up some de

partmen t ofthe heal ing art , or some master or explorer that had passed away but in an associationlike that he addressed

,l imited time did not admit

ofdiscuss ing abstract questions ofhis toric interest.Thus they were confined to those pol itic-medicalquestion s wh ich concerned them most . He deniedthe insinuation that the Association had no obj ectssuffi cien t for the exis tence worthy the labor

,

expense and time ofmeeting together,insist ing

that th is was the opinion ofthe il l-informed,whofail ed to perceive its advantages. Alluding to the

growth ofthe Medical Association ofour American cousins

,

” he (Dr. Hingston) said that al thoughnow after an existence ofon ly th irty years foundto be almos t too largefor practical purposes

,the

society must be admitted to have accomplished anam ount ofgood not to be achieved by any othermeans. I t had brought th e medical profession ofth e United States into one body and encouragedthe State institutions, thereby improving the tonein th em . So with the association he addressed

,

which had exis ted for only one-third ofthat period.

Legislation had imposed geographical boundariesand endeavored to make a fi t practitioner ofoneProvince disqual ified in another. The associationdefied al l efforts to fix l imits as ofa boundary

,and

rubbed out those unsightly enclosures . I t wasmatterfor gratification that the work ofthe sessionwould be divided in to section s— surgery and medicine— the other branches ofth e heal ing art to be

THE CANADA LANCET.

subdivided inEthese sections. EAlter allud ing tomatters ofroutine

,he touched upon the question

ofl egislation in the Province ofQuebec,where

three bills went in last session to satisfy threeorders ofmind , and came out as one bill

,and in

a shape that satisfied no order ofm ind .The

Province ofOntario system— a central ExaminingBoard— had been favorably pronounced upon bythe medical press and profess ion ofthat Province.The Province of Quebec had no such system yetnoth ing short ofi t would sat isfy those who lookedonly to the wel l-being ofthe profession and thecommunity. The compti ls ion , requiring personsl i censed in one part ofth e Dom inion to procurel1cen se in another, seemed an anomaly i t was one,however that could only be remed ied by a parityofmedical legislation in the several Provinces

.

Much more liberal was the action ofthe Engl ishCollege ofPhysicians in Great Britain

,which had

passed a by-law l egaliz ing even fore ign p racti

t1oners in England,and on certain cond itions

exempting them from re -examination. I t appearedto h im the duty of the Canad ian Association toendeavor to obta in such legislation as would lead toa l1ke generous action . I t was useless to speak ofm ed 1cal l egislation for the whole Domin ion

,but

local legislation could eas i ly in troduce measuresS lmultaneous ly so that a practit ioner in one couldbe a pract it ioner in all the Provinces . This couldbe done by cen tral examining boards and a un i *form system . In drawing attention to the act asat present existing, he showed that by the man ipu

lation of proxies one active man might controlmatters at any t ime for the whole Province

,mak ing

practitioners in the country and towns,unknown

to themselves, his instruments in so do ing . Havlug called attention to the refusal ofthe BritishBoard ofTrade to recogniz e Canadian qualificat1onsfor emigrant and passenger sh ips

,so

cen tly before the publ ic,he explained that

al though the Board of Trade had resc inded theorder, i t-was nevertheless a law,

to be used by theBrit ish authorities at an y time. The d iplomaswere not recogn iz ed

,but their holders were allow

ed to be employed. And how could Canad iansask for the recogn i tion oftheir diplomas in Britainwhile they refused to do so in their own country.

Allud ing to the ungenerous act of a member ofth eprofess ion in Ontario towards a surgeon of d is tinct ion from Detro it

,he was certain that his asso

c iates in convention would allow h im to interprettheir views in assuring Dr. Jenks

,and through h im

themembers of the profess ion in the adjoin ing Union ,oftheir honest offered courtesy

,and of their con

tinned des ire for reciproci ty in matters wh ich evengovernments cannot control

,and in wh ich sci ence

and human ity demanded the most unfettered c iv il i ty .

Coming from the question ofthe education andqual ifications of a medical stude nt before enter ingupon the pract ice ofhis profess io n

,to the question

,

what should be h is qualifications on entering ourmedical schools ? he said the education he would ad vocate should give a del icate taste , a cand id ,~e qu i table,d ispassionate m ind

,a noble and courteous bearing

in the conduct ofl ife should open the mind , correct

,refine , enable i t to master, know and d igest,

rule and use its knowledge, and give it powerover its own faculties, application , fiexi bility, methodcritical exactness, sagacity , resource, address.With the in tel lect thus tutored

,th e s tudent might

enter into the study ofthat most difficult profess ionof which we are members and pursue with advan

tage a particular course of study that might issue insome definite and perhaps remunerative work . Heshared not with those who advocated a low util itarian i sm ,

but rather with those who th ink the student should be formed “ not by a pars imoniousadmeasurement of studies to some defin ite futureobj ect

,but by taking a wide and l iberal compass

,

and th inking a great deal on many subj ects w i th nobetter end in view

,perhaps

,than because the exer

cise is one which made them more rational and intelligen t beings.

” But th is was not What had beenthrust upon them recently m an ill digested law re

lating to their profession,i n an important Province

oft his Domin ion , where our colleges and seminaries of learning have been degradedfrom“

th eirposition . The graduate in arts, the student whohad completed h is e igh t or n ine years curriculumat any ofour college s shou ld by that fact alone bequal ified to enter upon the study ofmedicine .But no

,our universi ties may grant degrees in arts,

bu t the colleges and affi l iated med ical schools override them and subj ect the candidate to a new or

deal,from which he should be exempt . In the days

of Samuel Johnsto n the phys ic ian was admitted tobe the most cult ivated and learned in any society.Could th is be said to-day of many countries in theworld— ofCanada ? There were cases, and notablyIreland

,where the phys ician is s ti l l among the best

educated gentlemen , and hi s social standard regulated accord ingly. Dr. Stokes in a conversationhad with h im (Dr. Hingston) in 1 86 7 , explainedthis by say ing : Nearly all our graduates 1n medic in e are graduates in arts . Of the last 98 , all haddegrees in arts . ” In some other countries thesame cond ition ofth ings obtains. Continu ing onth is theme

,he discrim inated in favor ofa l i beral

as in contradistinct ion to a crammed education .

They must be above the ir knowledge, not under it.I t was w i th medic ine as with pol i tics . There weretwo classes of those— one versed in thart of government

,and capable ofan

ofthe contentions of parties— th etranscript or copy of the las t editorial

THE CANADA LANCET.

i ted

sucion .

He quoted the wri tings OfHuxley and Spencer inproof ofh is s tatement. Speaking Of synthesis inmed ic ine

,he quoted past events and writings of

Schenck, ofVienna , and later our own Erasmus

disease but as experience isand w ith advantage to his

pat ients,to make a fewer number Ofremedies to

umber Of disorders .” He hadthe belief was strengthenedhe work Of grouping diseas es

should investigate th e air breathed,the water

drank and all that pertains to our habits as commun ities —to protect the pub l ic health was the

thropic though perhaps somewhat thankless task.

The convict ion was gaining ground that a Board

medicine,and passing

n with the Americand the original resolu1 8 7 5 , alluding to th ePhiladelphia

,That a

ons into one is desiradmirable manner inon

,had performed his

the present year,and

along with h is final11 as i nexpedient bework i ng machinery so

unwieldy as that organ ization would necessarily be .

He expla in ed,however

,that Canada never askedfor un ion of the two bod ies

,that the proposition

came from the Americans themselves in the firstplace . What the Canadians d id ask for, was

“ aconference at some central point

,so as to become

“ more intimately acquain ted and discuss medicaland surgical quest ions on a common basis . ” I fthe Canad ian representat ives at Philadelph ia askedfor a “ un ion ofthe Associations , they expressedtheir own v iews

,and did not speak for the Canada

Medical Association,which at N iagara in 1 87 5

asked merely for a medical conference,without

either Association losing its identity. Here thequestions connected w i th th e birth—rate Of countr ies was taken up . Before conclud ing his ad

dress,by spec ial request h e referred to the evil

wh ich was prevalent— more particularly in certainstates Of the adjo in ing R epubl ic— amongst someclasses ofth e commun i ty— the cri rri e of foeticide.He dwel t upon it in i ts social , moral , legal, rel igious and scientific aspects, and condemned i tin the most unmeasured terms .The address occupied upwards Ofan hour in

del ivery,and was l istened to with marked atten tion .

A vote Of thank s was '

m oved by H on . Dr. Parker,seconded by Dr. G . W. Campbell , and tenderedto the pres iden tfor his very able and interestingaddress .Dr. R oss , chairman ofthe committee on Med

icin e,read h is annual address

,and Dr. Howard ,

chairman ofth e committee OfMedical Educationand Li terature

,

” also presented his report.Dr. HOWARD,

seconded by Dr. Bell , moved thatthe Convent ion resolve itsel f into two sectionsMedicine and Surgery — to meetfor business attwo O ’clock. Carried .

The President named Hon . Dr. Parker, andDr. Canniff as chairmen ofthe respective sections .Dr. GRANT moved, seconded by Dr. Gibson ,

that the following gentlemen be named a C om

m ittee on Nom inations : Drs . Parker, Botsford,Cann iff

,Workman

,Fulton , Sweetland , Fenwick,O sler

,F. W. Campbell , Worthington , and R ottot .

The meeting then adj ournedfor an hour.The members met again at two O

’clock , anddivided in to two sections— medical and surgical .The following papers were read in the medical

sectionTricuspid Stenosis

,by Dr. R . P. Howard , Mon

treal treatment Ofempyema, by Dr . J . Fulton,Toronto ; plea Of insanity, by Dr. H orn ibrook,Mitchell

, 0 . economical aspects of publ ic san itat ion

,by Dr. Playter, Toronto .

The fol lowing papers were read in th e surgi calsect ionEpi thel ioma Of the eye

,by Dr. Alt, Toronto ;

gastrotomy and ovariotomy,by Dr. R ob i l lard ,

Montreal ; nas al p olypus, by Dr. R eeve ,Toronto .

D iscuss ion was had upon al l th e papers, but

54

want Ofspace compels us to forego publ ishing anyofthe remark s.In the even i ng the members of the AS S O C 1atIOn

and their ladies were entertained by the President,an “at home having been given in their honorby Mrs . H ingston . I t is needless to say that the

evening was spent pleasantly .

S EC OND DAY ’S PROC EED INGS .

The chair was taken by the Presiden t at 1 0

a.m

.The minutes of the previous day’s meeting

ere read and approved . Several new membersere elected and took their seats .

I t was moved by Dr. Fenwick, and secondedby Dr. R obi l lard that Sir John R ose, M .D .

, ofEdinburgh

,and Dr. Cormick , ofParis , be elected

correspond ing members . Carried.

Dr . THAYER gave not ice that at the next meeting he would mak e a mot ion wi th regard to vaccination and the keeping Of heifers from which toObtain pure vaccine for supplying the profess1on .

The R t. Hon . Lyon Playfair, M .D ., C .B .

, LL.

D. ,M .P .

,for the University of Ed inburgh , was in

troduced to the Association by Dr. Hingston, andwas requested to take a seat on the platform .

The R t. Hon . gentleman made a su i tabl e ac

knowledgement Of the honour paid h im . Dr.Taylor

,OfEdinburgh , was also requested to take a

seat on th e platform .

Dr.FULTON then read the report ofthe Corn

m i ttee on Therapeutics and New R emedies .”

Dr.Botsford next reported on th e subj ect Of

Cl imatology and Dr. Osler presented h isreport on Necrology.Dr

.WORKMAN, at the request Of the Assocra

t ion,read h is paper on Crime and Insan i ty,” in

general session . A short and In terestIng d IS

cussion followed the reading Ofth is paper, atthe close Ofwhich Dr. H orn ibrook moved , seconded by H on . Dr. Parker, That in the Opinion Ofth i s Associat ion i t is desirable i n all criminal trials,when medical Opinion suggests the probabIl ity Ofmental unsoundness

,the accused should be placed

under the superv is ion Of experts for a sufficientt ime to enable them to determ ine whether h e wasinsane or not at the time the crime was comm i tt

ed .

” Carried .

Dr.BOTS FORD moved , seconded by Dr , R eddy,

that the thank s of the Association be given to Dr.Workmanfor h is able paper.Dr

.HOWARD gave the fol lowing notice of

motion That i t is in the interest Ofj ust ice , thatwhen ante-mortem exam inations are to be made ,experts fam i liar wi th such scientific work shouldbe employed b y the Crown when procurable .

”

The meeting then adjourned .

The meet ing Of the Sect i ons commenced at2 .m .IThe following papers were downfor read ing in

the Medical Section —Add ison’s D i sease, by Dr.

THE CANADA LANC ET.

Ofthe Brain , by Dr. Proudfoot.

R eeve Ves ico-Vaginal Fistula,

Excision Ofth e Knee, by Dr. FOf Central Artery OfR etina

,byFor want oftime many Of

were not read but handed toPubl ication

,and will appear

Transactions.The Associat ion convened in General Session in

the afternoon . R eports were received from the

med ical and surgical sections.Hon . Dr. PARKER called attention to the in

crease Ofpapers sent in , and the n ecessity for thesession lasting three days instead Of two .

A mot ion to that effect was carried .

Dr. O S LER then read the following report Of thecommittee on nominationsPresident

,Dr.Workman

,Of Toronto Secretary,

Dr. David,Montreal Treasurer

,Dr. R ob illard,

Of Montreal .V ice-Presidents — Dr. McDonald , ofHam ilton

Dr.Worthington,of Sherbrooke , Que . Dr. Cowie , of

Halifax,N. S . 5 Dr. McLaren

,St . John

,N .B .

Secretaries — Dr. Sweetland, Of O ttawa Dr. F.

W. Campbell, ofMontreal ; Dr. John Black, ofHal ifax

,N . S . 5 Dr. Atherton, ofFreder icron .

Committees — On Publ ication , re-appo inted on

Medicine,Drs . Mullin , Of Ham il ton , and R oss and

Lamarche, ofMontreal on Surgery , Drs . Mal

loch, OfHamilton , G rassett , Of Toronto, and Far

rell,ofHalifax ; on Obstetrics, Drs. R osebrugh , Of

Ham ilton,U . Ogden

,ofToronto , and Trenholme,

ofMontreal .~O n Therapeutics— Drs. J . E. Ken

medy, OfToronto

,A . H . Kollmyer, OfMontreal ,

and Woodhill ; 011 Necrology, Drs . R idley, ofHamilton

,Lachapelle

,of Montreal , and Burges s,

Of London ; on Medical Education and Li terature

,Drs. R eddy, Of Hamilton , M ichaud, Of Ka

mouraska,and Howard

, ofMontreal ; o n Cl imatology, Drs . Playter, of Toronto, Larocque, OfMontreal

,and Jennings

,Of Halifax.

Hamilton was chosen as the next place Ofmeeting

, on th e second Wednesday in Sept ,1 8 7 8 .

Dr. MULL IN moved the following gentlemen onthe Committee ofArrangements , wi th power toadd to their number. Drs . Malloch , McDonald ,R idley

,G. McKelcan and the mover, wh ich was

carried.

A report of the Auditing Committee showed thereceipts for the year to have been d isbu rsem en ts, balance in hand ,I t was dec ided to print the transactions of the

Associat ion at an early date,and . a subscription

was Opened for that purpose.

Dr. BELL gave notice that at the next meeting

https://www.forgottenbooks.com/join

5 6

est to many strangers who found i t wel l worthy Ofa visit

,where they were shown all the latest im

provemen ts in th e pharmaceutical art. At thebranch establishment

,Ph ill ips’ Square , ( there be ing

two establishments belong ing to the firm) v is i torshad an Opportun i ty ofseeing the new wonder

,

The Telephone,

” in constant use,the two es

tabli shm en ts be ing connected by telegraph for therapid transm iss ion of messages

,orders, and ex

change Ofprescriptions . Among the ir spec ial tiesmay be mentioned the new method Of adm in istering med icine by way of “ wafer capsules,” wherebythe most disagreeable medici nes may be read ily swallowed by e i ther adul t or ch i ld.

Messrs . McKesson and R obbins , ofNew York,

exhibited through the firm OfKenneth Campbell 81&c.

,an assortment of 300 variet ies Of the ir gela

t ine coated p il ls,which are rel iable and elegant

preparations . These pills are ofthe sphero idal orcapsule Shape and it is cla imed that In this formthey are best adapted for swallow ing and obv iatethe s ickening sensation S O universal i n swallowingthe round p ill . This house has acqu ired a highreputation in the Un i ted States and Canada, forthe rel iab i li ty

,elegance and purity Oftheir prepara

tions .Messrs. John Wyeth B .ro , ofPh iladelph ia

,

made a very large and interesting exh ibi t ofveryelegant new and useful preparations including . thelatest idea in pharmacy

,namely compressed pow

ders in pill s . By this means powders are madeto assume the form ofsmall loz enges and areconvenient for carriage and easy of adm in is trat ion .

Under this form they exh ibited pil ls ofarsen ic,

sal icylicacid , podophyll in , b ismuth , Opium ,calomel

,

qu in i ne, c inchonidia, morph ia, phosphorus, p il .cath . C O . , &c .

,&c . The ir preparat i ons ofdialyz ed

iron,lacto-phosphate Ofl ime with cod 11ver o il

,

el ixir ofbeef iron and wine , syrups , medicatedwines

,&c. ,

in great variety— d isplayed a h ighdegree of excellence 1n the art Of pharmacy. The irpharmaceutical preparations are excellently prepared with much sk i l l. The usual nauseous taste Ofthe drugs are greatly disguised and prescriptionswh ich extemporaneously prepared would presentan inelegant appearance

,are rendered clear and

pleasant to the taste, without detract ing from theirmedicinal value

,as ev idenced in the ir el ixir gen

tian and tincture Of iron , bark, iron and bismuth ,valerianate of ammonia

,iron , qu inine and strych

nin e,emulsion ofcod-l iver o il and l ime, wh ile the

elixir of beef iron and wine is more agreeable tothe stomach than beef tea.The compressed powders or pills can be readily

swallowed on accoun t Oftheir flattened shape.The bulk of the powder is considerably reducedby pressure

,yet as ne i ther mo i sture n or excip ients

are employed,the medicine dis integrates readily In

most cases,th e most prom inent exceptions be ing

the potassium chlorate and ammon ium mur iate

THE CANADA LANCET .

' O

wh ich are purposely compressed wi th greater forceas they are mostly employed for local effect uponthe throat

,and are convenient for singers and

publ ic speakers .Messrs. W. H Schieffel in 81 C O .

, ofNew

York,made a very interesting exhibit of soluble

p i l ls . These p ills are coated w i th a tastelesstransparent soluble covering, readily melting awayin the mouth . Among the l ist are p il ls ofphosphorus , qu inine , sulphur , morph ine, pil . cath . co.

and other standard pills . Preparations Ofremed iesi n soluble form is a triumph of no mean value inpharmacy.

All the preparations exhibited were of the mostperfect character and deserve the atten t ion ofphysic ians In prescribing

,for the more agreeable

the form i n wh ich a med icine is adm inistered , thebetter pleased wil l the patient be

,and the greater

the success of the practit ioner.We .were very greatly pleased to observe the

rivalry that now Obtains between the better classOfpharmaceutists in the ir determ ination to vie w itheach other in their endeavour to place at the d isposal ofthe profession

,med ic ines at once elegant

,

accurate and rel iable and withal so palatable thatany chi ld or lady may take them w i thou t the sl ightes t repugnance . Th is fact

,in i tself, will remove

one of the great obj ections of the day to regularpractit ioners

,for there can be no doubt but that

the carel ess,crude

,and to many

,d isgustingly d is

agreeable way in which so-calledAllopath ic remedieshave been adm in istered in the past has been agreat source Ofweakness

,wh ich taken advantage of

by Homeopath ists has enabled its votaries to obtaina very large army Of converts wh ich they couldnever have gained had such preparations as thoseexhibi ted by the pharmaceutists above namedbeen in general use by the profession .

We welcome this new era i n pharmacy and wethank our pharmaceutists for the displays made,Shewing the care and interes t taken to second theefforts of professional men by providing the bestcharacter poss ible in medicinal preparations .The Galvano Farad ic Manufacturing C O . , of

New York , represented by Mr. R e id, exh ib itedsome very powerful and elegantly made electricalapparatus for med ical use. The med ical use Of electr i ci ty is becom ing better understood, and morefrequently resorted to ofcharacter of the in strumecompany leave no roomofadaptab il i ty in

THE CANADA LANCET. 5 7

ims to

proper

cohec

i tten tion ofthe profession being thus drawn towhat they have missed by not being presen t wil l:ause the next convention , i n Hamilton , to be morerumerously attended by members Of the profes

gtttdicat gums and films.

S INGULAR SOURC E OFLEAD PO IS ON ING.- A

)ffresh cases were reported in various houses,

nos tly i solated , several ofwhich were very severe .They had al l in common

,i t appeared

,sen t their

orn to be ground at the same mill. Dr. Alfordccord ingly visited and inspected the mill , and thefrigiu ofall th e misch ief was at once apparent . On.aving th e millstone raised, he found th e surfaceifeach stone hon eycombed with lead . The milltone being ofa loose nature

,large spaces had oc

arred, wh ich Oflate,during the illness Of the

wuer, had been fil led up by pouring in quantit iesf molten l ead . The firs t grinding Of wheat after

mills tone,and th e

fi lled up with th e same metal .

5 , by which is meant the smu t orian Corn , has been employed fors as ergot Of rye, and with repun siderable attent ion is bestowed

TREPH IN ING THE TYMPANUM WITH SUC C ES SFORDEAFNES S .

— Dr. Bonnafon t,th e well-known aurist,

has j us t publ ished the particulars ofthe abovecas e

,which had excited much interest here at the

time the Operation was performed . He treph inedthe tympanum a year ago in a young girl oftwenty,who was suffering from deafness, which nothingcould remove. She could hear the ticking Of awatch when appl ied to the skul l. The tympanumwas perforated by means of a special trocar, andan accompany ing cannula, provided with smal lwings

,wh ich could be pushed out ad l i ’bi tum , was

left in the tympanum . R estorat ion ofhearing tookplace instantly. Twenty days after, symptoms Ofinflammation

,swell ing

,and abscess showed them

selves ; bu t as they were confined to th e middleand external ear

,and as there was no headache or

fever,poulticing and inj ecti ons were ordered, and

th e cannula was left in i ts place. A month afterward al l these phenomena had disappeared , andthe cannula fell out. I t was then seen that th ehole made by the trocar in the tympanum was perfeet and unimpaired. The patient is now quiterigh t and h ears well. Dr. Bon nafon t th inks thatthis i s a great triumph in aural surgery, and thattrephin ing ofthe tympanum wil l take the samerank and render the same service as removal Ofthe cataract in eye surgery — Par i s Letter to MeLancet

,July 28

,1 8 7 7 .

— T/ze C l in ic.

B ILIOUS ATTAC KS .— Dr. Fothergill ( in Med i cal

s es ) says the treatment ofbil ious at tacks towhich dark-complexioned persons of the bil iarydiathesi s are most subj ect : R arely do persons ofother diathesis and fair persons suffer from thosedisturbances which may fairly be said to be con

n ected with the presence ofbile acids in excesswh ile as to those forms ofbil iary disturbance wherethe u rine is laden with l i thates

,the condition Dr.

Murch ison calls l i thaemia,persons ofother diatbe

sis seem equally l iable to them,and they are found

in fair and dark people al ike. For those biliousattacks

,then

,which occur chiefly in those ofth e

bil ious diathesis noth ing is so good as alkal inesal ine purgatives taken l n some vegetable infusionimmed iately on getting out ofbed In the morning.

This should be washed down with some warmfluid which excites the peristal tic action ofth ebowels

, and , i f necessary, a vegetable laxative pillshould be taken the night before. After a coupleof l iquid motions— the more copious the betterthe bilious person feels pretty equal to the day

’

swork before h im . R ochelle sal ts wi th a l ittl e sulphate of magnesium in infusion ofbuchu forms a

most excell ent morning purge,i n my experience.

Sir JosephFayrer has found In his Indian expen

ence sulphate Of magnesium,with quinine or gen

tian,suffi cient to produce two or three loose mo

tions,an efficien t measure in bil iary congestion .

S outhern M ed . R ecord .

5 8

CHANGES OFTHE PUPILS IN CHLOROFORM NARC O S Is .

—In the surgical clin ic i n Gottingen duringthe past winter

,th e changes in the pup ils during

the administration of chloroform were carefully Observed in 1 22 cases. Previous to and during thes tage of excitement

,th e pup ils were

,in most ofthe

cases,of the usual w idth in a few cases , j ust b e

fote the stage ofcomplete insensibil ity, they werequite wide and sensitive of l ight. During the stageofcomplete insens ibil ity they were closely con

tracted in 1 20 ofthe cases, and were absolutelyimmovable in 1 1 9. An instantaneous d ilatat ionofthe pup ils in this stage was found to be a threatcu ing symptom of chloroform po ison ing. Th isoccurred in two Ofthe cases , in one of which thetrouble seemed to be located in the heart

,and in

the other in the lungs ; in both, l ife was restoredby pull ing forward the j aw and resorting to artificial resp iration .

The fol lowing pract ical lesson has been deducedfrom these observations : When , during the stageoftolerance the pupils begin to d ilate slowly, i t isa S ign that the patient is recovering from the narcos is, and more chloroform must be g iven when,on th e other hand, the pupils become suddenlywidely dilated

,the administration of chloroform

must be at once stopped, and further troubleguarded against — C en tralblattfor C hi r urg zh, June23d . (M ed i cal R ecord .)

THE IMPORTANC E OFC INcHo-QUIN INE AS A

R EMEDY.—The Supervising G eneral ofth e Marine

Hospital Service has issued a circular letter to themedical officers of that branch of the Treasury inwhich he calls their attent ion to the extraordinaryi ncrease in the market price of sulphate Of qu inia,and at the same time alludes to the success attending the employment of the other alkaloids of th ebark.

In the year 1 866 the Madras Government appoin ted a Medical Commission to test the respec

t ive efficacy In the treatment offevers ofqu in ine,quinidine

,cinchonine

,and c inchonid ine, and the

remedial value ofthese four alkaloids as deducedfrom their experim ents is shown by the followingstatement

Quin id in e , ratio offailure pr 1000 cases, 6

C inchon id ine, 11 11 n 11 I O

Quin ine , 7C inchon ine, 23

Cincho-qu inine contains al l these alkaloids , andthe combination has proved more efficacious thanany one alone ; and the price of th is article be ingless than one half the present price ofsulphate ofquinine

,the phys icians of th is coun try are substi

tu ting i t for the sulphate.the Government service should give th is subj ect

The medical Officers of

THE CANADA LANCET.

Yorh M edical y onrnal , June, 1 87 7 .

GOUT SUC C ES S FULLY TREATED BY SALIC YL ICAC ID . Dr. R uhe contributes to the D eutsche

Zei tschr .f. p r . Med . the account ofan exceed inglyobstinate case ofgout, which had resisted all otherforms of treatment

,but which was promptly reliev

About two and one-half draching th e first twenty-four hours .th e patient was entirely freeagain able to walk about. Hisregained

,and at the t ime of

months after treatment, noplace. — Allg. M ed . C en t. Ztg.

, No.

A PULS E OFTEN BEATS PER Med in the Paris G az . M d icale.

pernicious algid fever. After severalstated rate

,i t rose to tw enty-five , an

from twenty to twenty-eigh t for threepatient died.

E SMARC H’S BANDAGE i s already 10due consideration in preparing their requisitions amputation , owing to frequentfor

_m ed ical suppl ies. Wash i ng ton , D . C . ,

D ai ly haemorrhage following its use.Nation

,Auguz t 8, 1 8 7 7 . sum ing the O ld tourniquet .

A NEw METHOD OFCUR ING POPL ITEAL ANEUR ISMS .

-Dr. Martin Burke,Of Bellevue Hospital,

reports three cases ofpopliteal aneurism,that were

cured by compre S ion ofth e femoral artery bymeans ofa con ical bag fil led with shot

,which was

suspended from a heigh t in such a way that theapex ofthe cone pressed on the artery in Scarpa’striangle . In the firs t case pulsation in the an eur

ism ceased in eigh t days in the second,in sixteen

days ; and in the third, in s ix days . The curewas slow i n the second case

,on account ofthe

patient’s neglect to keep the apparatus in place.During the treatment li ttl e or no pain or uneasinesswas complained ofin any ofthe cases.The shot-bag was made ofcanvas, in the form

ofa flattened cone,the apex measuring one inch

in diameter. A rounded p iece ofcork or Indiarubber, one inch in th ickness , was fi tted accuratelyinto the apex ofthe cone

,and a long thin rod

reach ing down to and resting on the rubber or corkwas then inserted and held in the middle of thecone while the shot was poured around i t, untilthe bag weighed

THE CANADA LANCET.

TOR ONTO,OCT. 1

,1 8 7 7 .

CANADA MEDICAL ASSOCIATION .

The Association held its tenth annual meeting at

Montreal , on th e 1 2th and 1 3th ul t. , and was pre

sided over by Dr. Hings ton,the worthy president

,

wi th his u sual grace and abil ity . The meeting sur

passed in success and general interest all that have

The attendance, although not large,qual ity what i t lacked in numbers

,for

we seen such an array ofdistinguishedas on th is occasion . The

seemed to have been propi tious for the

er was E ly sian i t self, while from over these as

presen t the R ight Hon . Dr. Lyon Playfair,

and his fellow traveller,Dr. Taylor

,of Ed in

From the n eighbouring R epubl ic were

The President’ s Address,an

of which will be found in another column,

s terly and exhausti ve. To fol low him

the various subj ects and l ines ofthoughtd would be a work ofsupererogation

,but

one or two poin ts to which we desire to

rs t, his advocacy ofa highereducational attainments before

5 9‘

many skilled artizans are infinitely their su'

periors,and yet we have known such men occupying profess ional chairs in teaching bodies. Th is ough tnot to be

,and in a profession that is ranked as one .

ofthe learned professions there should be admittedno l iterary ignoramuses. A good preliminary

train ing is the surest d iciplinary preparation for the

s tudy ofan exact science,bes ides affording a vast

fund of usefu l collateral information which is ofinfinite value to a well instructed practit ioner.

Another subj ect alluded to,v i z .

,th e prevention

ofoffspring,is becoming a growing evil among

some portions of society,even in Canada, as well

as in the bordering States where the evil has

assumed alarming proportions . The duties ofmotherhood are repugnant to many ofthe respectable (P) women ofmodern society,— and notalone among the unmarried unfortunates are these

evils to be looked for— but al so among th e middle and uppe r classes

,where too often the hus

band is qu ite as inten t upon the evil course , out ofconsiderations of false kindness towards the

woman,as the woman is h erself.

In other matters the address abounded within fo rmation and valuable suggest ion

,and altogether

was qui te in keeping with the au thor, the circum

stances and the occasion .

In th e Medical Section over wh ich Hon , Dr.

Parker so ably presided, several very interest ing

papers were read and discussed . The paper ofDr. Howard on Tricuspid Stenosis . aecom

pan ied by the specimen preparation was most in

terest ing, and the explanation following the discus

sion cast much l ight upon what to most practi

tioners i s a very rare and li ttle understood affection.Dr. H orn ibrook

’

s paper on the Plea ofInsanity,”was though tful

,clearly defined and interesting.

Owing to the importance ofthe subj ect, and alsoas a mark ofrespect, Dr. Workman ’s paper onCrime and Insan ity was r eserved for reading in the ,

general session . I t was the paper ofthe Association ,

and deserves to be widely circulated not

on ly in th e medical bu t also in the popular press,from its valuable information and suggestions re

specting the relations between crime and insan ity.

I ts reading was followed by the passing of a reso

lution in regard to the plea ofin sanity,” broughtforward by Dr. H orn ibrook, and amended in the

general session . I t will be found in our report .

Ofproceedings . Dr. R oss ’s paper on Addison’s

60

Disease,” with illustrations and specimens

,excited

a good deal ofinterest,and brought out several

new and important facts concerning th is raredisease.

The most interesting discussion took place inthe Surgical Section

,presided over by Dr. Canniff

with h is usual ability. In this section some ofthepapers on the programme

,for want of time

,could

not be read ; among others , one by Dr. Canniffonthe “ Treatment ofWounds.” A letter was re

ceived from Dr. R osebrugh expressing regret atnot being able to be present to read h is paperon

" Ovariotomy.

" The paper by Dr. Alt, of

Toronto, was brief, but of an unusual degree ofin terest. Dr. R eeve, ofToronto

,was down on

the programme for two very interesting and praeti cal papers, on e on

“ Optical Defects,

” and the

other on Nasal Polypus.” Dr. R obillard’s

paper upon Gastrotomy and Ovariotomy,in

which he exhibited Pean’s instruments,used in

the operations ofovari otomy and hysterotomy,

excited considerable i nterest and discuss ion,which

brought out the fact that hysterotomy had been

performed for the first time in Canada by Dr.H ingson , of Montreal , who frankly admitt ed,however, that in doing it , he was doing mor e than

he had intended or expected to do. I t appearedfrom the statements ofDr. Kimball the veteranovariotomist Of Lowell

,U . S .

,that Pean not unfre

quently commenced ovariotomy by la peti te op era

tion,but finished with la grande operation .

The criticisms on the different papers weresuffi cien tly pungen t in this section , but withouttaking from the interest or value ofany, i t mustbe admitted that the kind and sensible criticisms

ofDr. K imball were perhaps the mos t in terest ingfeature. His voluntary criticisms were lengthy,but even after these were closed, he continued to

reply to the questions of various membe rs present. Dr. Kimball seems averse to the operation

ofhysterotomy, and advises its performance onlywhen in tense suffering

,with the importunities of

the patient and friends,would render it warrant

able. Ne i ther d id he consider either ovar iotomyor hysterotomy as Operations to make the repu

tation Of a surgeon, S ince recovery often followswhere leas t expected, and vice versa, fai lure ofrenattends where everything seemed to ind icate a

reasonable hope Ofrecovery. The addresses ,papers

,criticisms and illustrations , were appro

THE CANADA LANCET.

priate, pointed,instruction

,wh i

the enthusiasm with which Dr.

received by the Associati on , or

gratification fel t by the members in l istening to thevery suggestive and eloquent address of one ofwhom they had read and heard so much . H e

was elected an Honorary Life Member. The

publ ic dinner was a grand entertainment, and waslargely attended. Everything

,in short , passed Off

in the most satisfactory manner and reflected much

credit upon the committee of arrangements, and

its act ive and obliging Secretary. Dr. O sler, ofMontreal. We can hardly say

,however, that we

approve ofspl itting up the Association into two

sections. I t is rather premature. I t makes the

attendance in each section too small , and thus

detracts from the interes t which would arise from

a more extended criticism ofth e papers read.

When the Association numbers by hundreds , i t

will be time to think ofthese and other subdi

visions.

THE POISON IVY AND ITS R EMEDIES .

Poison ivy,rhus tox icodendroiz poison vine or

climbing ivy,

rhus radi cans ; po ison sumach or

swamp sumach,rhus ver n ix ; and poison elder,

poison dogwood,rh i es venenata ; are all plants of

th e same family. Their juice, when appl ied to theskin

,has the effect ofproducing inflammation and

vesication ; and the same po1sonous property i s

possessed by a volatile principl e which escapes

from the plant itself,and produces, in certain }

persons,when they come into its vicini ty, an ex

ceedi ngly troublesome erysipelato us affection , par»

t icularly of the face. There is frequently itchingand redness, a sense ofburning, wi th tumefaction ,vesication

,and ul timate desquamation . These

effects begin immediately after exposure and us

nally decl ine with in a week.

and these washes may be used as

well as remedies . Our fore-fatherss ion depended upon a light cool ingsal ine purgatives

,and the local use

THE C ANADA LANCET.

be the most rel iable remedies, such as a solut ion vail ing prejudice s ofth e common people in someOf pure carbonate of. potassa, or sal t Of tartar. district or country. Thus was i t with the dis

C arbonate ofpotash procured from cream -Oftartar, covery ofvaccination . Sir Wm . Jenner merelyis preferabl e to that obtained from pearl-ash in deduced an important scientific truth from the

these cases . I t should be used ofth e strength Of vague notions and common prej udice of th e dairyTWO ounces to eigh t ounces Of water, and applied people ofGloucestershire, in England , who strenuto the affected parts several times daily. Strong ously held that no one who had ever had sore

suds,made from soft 01

’ lye soap , white lye, fingers or hands from catch ing th e cow-pox while

.ammonia water— two to three desert-spoonfuls to a milking, ever took the small-pox or could be in

a pin t ofwater— or a l it tl e saleratus dissolved in oculated . And th is was very eas ily remarked,for

water,are excellen t washes . White lye is made by th is fel l disease in those days ravaged and laid

throwing two quarts Ofhardwood ash es into a pail waste whole cities and districts ofcountry, destroyOfwater, st irring and then al lowing i t to settle ing its tens ofthou sands , without any check or

the clear supernatan t l iqu id is wh ite lye . rel ief being afforded from the physicians ofth eWhen a person is exposed to th e influence Of day. In l ike manner has i t been w ith most of

these plants,which when bruised or cut , have the th e importan t remedies ofth e now extens ive

power ofaffecting som e skins when several feet materia medica, natives or common peasants indistant

,al though most persons require to touch the most instances affording th e information wh ich

,

plant before i t affects th em , he should wet every being developed, has l ed to the discovery and

part ofthe skin that i s l ikely to be exposed or nu classification Ofmany invaluable agentsfor th ecovered

,with one or another ofthese washes, al refiefofdisease.

lowi ng the wash to dry upon the skin , by no Following up th is l in e ofobservation,we find

means wiping i t off. This plan is said to protect the roving gypsies and horse j ockeys ofmost counthe skin from the poisonous influence ofthese tries giving arsenic as a remedyfor broken wi ndplants

.In th e same manner, if one has been ex and heaves in horses , andwith astonish ing success,

posed, or fears he has, le t h im follow th e same improving th e general condition ofth e animal

,

p lan and allow th e wash to dry upon the skin . giving h im a fine heal thy skin and sleek coat, also

Where the skin has already become red and removing th e diffi cul ty ofbreath ing. The,only

swollen , and there is i tching and st inging, these difficulty with its use was, as they say, that onceby means of cloths begun, i t must be continued. In these cases i tto dry upon th e seems to act by stimulat ing the secretions gener

ally,especially that ofthe sk in , and improving th e

digestive function . This practice has been found

common among the Arabs and wandering Tartars.made too per The northe rn C h inesefuse arsenic daily

’

,mixed

s everingly,i t may happen that metastisis to the with their smok ing tobacco . And according -to

bronchial mucous membrane may take place, and M , Mon teguy, formerly French Consul in China,urgent sense Of tobacco free from arsenic} i s not sold among theth e appl ication northern Chinese. The Consul was assured by

relief. AS pre missionaries who had l ived a long time among th epersons Should natives

,that th e arsen ic-smokers were stou t fel

Ofthes e pO i SOH lows,with lungs l ike a blacksmith ’s bellows, and

plants when practicable to do so . rosy as cherubs. The las t statemen t brings to

mind the fact that in Syria,Persia and Arabia, -the

OKING AR SENIC IN'

PHTHISIS PULuse of arsenic is indulged

.

in by ladies , desirous ofMONALIS .

beau tIfymg the complexi on and Improvi ng thegeneral appearance . I t Is an 1ngred 1en t In almos t

a notable fact that many ofour most im i n every cosmetic ofthe eastern countries .iscoveries in medicine have been bor The publ ication ofM . Mon teguy

’

s statementsdeveloped from general proverbs or pre with respect to the Chinese ars enic-smokers, called

62

forth a letter from a Dr. Loude, who announced

that some years previous in a course ofa discussion at the Academy of Medicine , Paris, on the

agents to be employed to cure tubercular con sumpt ion . He told the assembled doctors that he had

found bu t one successful means of combating thedreadful disease— that means, was the. smoking ofarsenic

.He reaffirmed h is commendation of th e

remedy.Trousseau

,than whomfew are more emi

nent, recommends the inhalation ofarsenic, bymeans ofcigarettes saturated in a solution containing from 5 5 59 —5 j. to the gj. ofarsen iate ofsoda,in th e treatment of phth isis pulmonal is. In weak

states ofthe system ,{as in the course ofphthisiswhere dropsy ofth e cellular t issue supervenes

,

arsen ic is found beneficial in removing the anasarca,apparently acting as a tissue stimulan t. Wh ile notforgetting th e dangers of an over dose ofthis tremedy

,we feel from personal observation ofi ts

beneficial effects in lung troubles, including phthisiswi th emaciation , especially bronchial phthisis ,spasmodic asthma, bronchitis and catarrhal affecti on s, when smoked in the form ofthe arseniousacid commingled with

'

a j ust proportion of_ s tra

mon iumgleaves and lobelia, with nitrate of potash

to Secure combustion , that it cannot be too h ighlyrecommended in the treatment Of lung affections,when its administration can be regulated by a

competent physician .

CONTAGION OFaTYPHO ID.— At th e close ofa

seri es of l ectures on th e laws ofheal th , recentlydel ivered infiLondonJby Dr. W. H . C orfield , Pro

fessor Tyndall made a few remarks upon the germsofdisease .h R eferring to the action ofdecomposingan imal matter in giving rise to disease, he said thatfor twenty years he had been In the habit of visiting the upper Alpine valleys, where, among the

Swi ss chalets, therefwas the most abominable decomposition constantly going on , and there were

also exceed ingly bad smells ; but in that regionsuch diseases as typhoid fever and small-pox were

ord inarily en ti relyZunknown . If, however, a person

suffering from typhoid fever were to be taken there,th e disease wouldgspread l ike wildfire from the infected focus, and would run through the wholepopulation . He agreed with the lecturer that the

contagion ofeach of these d iseases is unchangeablein its nature ,gs ince}we n ever find the virus of one

ofthem producing theiother.

THE CANADA LANCET.

The following is a verbatim copy ofa notice published in the Medical and Phy s ical 7 oarnal

,January

,

1 800. MED I CAL THERMOMETERS .-Dr. Currie

, in

his excellen t work on fever,having evinced the great

benefit often derived from the affus ion Of coldwater, practiti oners in the army and navy, as well asphys icians to publ ic institutions

,became desirous

of avail ing themselves of the use of a remedy so

cheap, pleasant and effi cacious.For thi s purposeit was necessary to ascertain the heat of the body

with a degree ofprecision,for which the hand of

the practitioner can seldom be rel ied on thermo

meters were therefore recommended,and we have

at length Obtained a specimen that appears perfectly

satisfactory. The scale is attached to thethe whole instrument is contained incase about five inches long

,and a q

inch in diameter therefore sufli cien tly portable.As the instrumen t is designed for the purpose

ofascertain ing the heat Ofthe human body, i tsrange is very limited in order to Obtain the requis itesensibil ity ; i t extends from about 80

° to 1 1 2°and

i s so sensible that it will indicate the heatto i t in less than ten seconds

,and th e so

be read to a quarter of a degree. I t

scarcely necessary to caution our readers

1 12°

,as it might endanger the instrument.

Gentlemen In the country may be suppl ied wi thsuch thermometers as above described, or with

those ofmore extensive scales, i f desired,and Howard, Chem ists,Plough Court,Street

,at about 1 8 shill ings each .

ETHER AS AN ANIESTHETIC .— It cannot be too

often repeated that ether is a much safer

much more sudden ether gives warn ing.

former produces syncope,which is sudden

unexpected,the latter

, asphyxia, which is ,a

process,and being plainly visible can be reme

at any moment by admitt ing air to the lungs.

https://www.forgottenbooks.com/join

64 THE CANADA LANCET.

BEWARE OFG AS .— The last number of the Lan COR PULENC E TREATED WITHOUT S TAR VATIO

cet reports the death ofa surgeon in Manchester O R , HOW TO G ET THIN,by M M G riff]

who inhaled gas for the purpose ofhaving teeth M'D" Parsons, Luz erne County, Pa.

extracted. The patient insis ted on having the gasTHE U SE OFOBSTETR IC FORC EPS IN ABR EVIATI

given to produce i ts full effect. When the opera THE SEC OND STAGE OFLABOR, by Edwardtion was completed it was found impossibl e to Dunster

,M .D .

,Ann Arbor Med ical College

.

rouse h im. The post mor tem showed fatty degen

crat ion and valvular disease of the heart. PATHOLOGY AND TREATMENT OFSPRAINS ,R ichard O. Cowl ing

,A.M.

,MD .

,Prof. ofOp

APPO INTMENTS — J. Mahafi’

y, M . D . of Clarks ;tl ‘

fioii

gfeéybyn ivemi ty Of Lou isvi lle : JOville

,to be an Associate Coroner for the County of

S imcoe . Dr. Wm . McNaughton Jones has been ON THE U SE OFLARGE PROBES IN THE TREIappointed Medical Superintendent of the British MENT OFSTR IC TURES OFTHE NASAL DU <Columbia Insane Asylum . Dr. J . D . Bryant has by Samuel Theobald, M'D

"Baltimore Eye a

been appointed l ecturer on Anatomy in BellevueEar D i spensary Facul ty Of Maryland

, 1 8 7 7 '

Hospital Medical (301168 3 : in place Of Prof. A B THE MED IC AL INTELIC ENC ER,containing a l

Crosby,deceased . J . S. McC allu

'

m, M .D . , ofofnew books

,and a class ified l ist Of other wor ‘

Sm i th ’s Falls,to be an Associate Coroner for the Also a condensed classified l istfor the PO Ck

County ofLanark.(Free ) Ph i ladelph i a : Lindsay Blakiston .

PERS ONAL — Dr. G. S. R yerson , Of TrinityPRAC TICAL H INTS ON THE S ELEC TION AND H (

TO U SE THE M IC ROS C OPE,for beginners

,Medical School has been appointed house surgeon John Phin Editor of the American JournalOf the R oyal LondOH Ophthalmic Hospital , Moor Microscopy. Second ed i tion

,i llustrated ai

fields. He is also cl inical assistant at the Central enlarged. New York : Industrial PublicaticLondon Throat and Ear Hospital, Gray

’s Inn

R oad.

INTRODUC TORY LEC TURES OFTHE MED ICALSC HOOLS — The introductory Lecture Ofthe Med ical Faculty Of McG ill College, Montreal , was de

l ivered by Prof. O sl er Bishop ’s College, by Prof.Kollmyer, and Trin ity Medical College, Toronto,by Prof. Kennedy.VITAL STATISTIC S .

-The number Ofbirths,

deaths,and marriages registered in Toronto during

the month of September, ar e as follows : births,1 78 deaths

,1 62 marriages , 96.

In Toronto on the 8th ult . , the wife OfDr.Burns

,Ofa son .

I n Toronto on th e 9th u lt., the wife of Dr.T. Fisher

,of a daugh ter.

$ 0035 and fiamphletfi.

A I KEN As AHEALTH STATION , by W. H . Gedd ings,M

.D .,Aiken, S . C. Walker, Evans 8: Cogs

well.

At Embro,F i tzgerald Sutherland, M .

Norwich,to J ean eldes t daughter OfD . Ma

Es’

q.

SOME GENERAL IDEAS CONC ERN ING MED IC AL On the 1 8th ult ., by the R ev. G. G.

R EFORM ,by David Hunt, M .D . : Boston : A.

Will iams Co.

R obert Thomson , Esq.,Port Stanley.

EXC I S ION OFTHE LOWER END OFTHE R EC TUMIN ' CAS ES OFCANC ER , by John B . R oberts,M .D .,

Ph l ladelph l a : Sherman C 0. w i t}; the ( onzflzu n icaz‘

iwz,

This is a small but very u

book,wholly intended for beg

'

ful l description of the various

scope and their uses,together

regard

mens,dry and moist. The work is an

dispensable accompaniment ofthe mand should be in the hands Of all Whom encing the ir microscopical studies .

THE CANADA LANCET.

Ii ANADAA MONTHLY JOURNAL OF

ANCET,

MEDICAL AND SUR GICAL SCIENCE .

TO R ONTO , NOV. I ST, 1877 .

Original Unmmuuirstiuna

ON THE SPECIFIC ACTION OF LAR GE

DOSES OF LIME-JUICE,IN THE TR EAT

MENT OF ACUTE, SUB-ACUTE AND

CHR ONIC RHEUMATISM .

BY A. H . C HANDLER, M.D., DORCHESTER, N. B .

The recently reported cases of rheumat ism ,fai lu res , as well as successes, w i th sal icin , and sal icyl icacid, have induced me to bring to the not ice ofthe

Oflarge doses of l ime orFrom among the var ious methods oftreatment advoos ted from t ime to t ime —acid

,or alkal ine ; mint

water, or expectan t Op iate or sal icyl ic— each ofwhich , with the except ion ofthe latter

,now on i ts

t rial , have i n turn been taken up and abandonedthe young pract i t ioner must often be sorel y puz z ledin his choice of a remedy

,when called upon to make

a selection .

In advocat ing the l ime or lemon j u ice treatment,

the author cannot of course,presume to suggest any

thing novel 5 but, he does venture on claim ing ori

ginal ity, w i th regard to the largeness andfrequencyofthe dose, and hes itates not to offer i t, when sogiven, as a veri table specific in th is not seldomt reacherous, and i n tractable malady . W i thout regard to the cond i t ion of the bowels, unless prev iouslymuch const ipated, I usual ly beg in w i th at least ten

increas ing rap idly up to eighin the 24 hours— from hal f an

or more ‘

every hour,w i th not

ofcold softhowever

,to

second day,

d isease,in

or asthen ic,

day oftreatgiven

,w ith

65

or wi thout lead, and tann in , n ight and morn ing, inorder to res t ra in the bowel s

,wh ich the j u ice has a

tendency to relax . The first effect of such heavydoses i s the rap id d im inut ion of j oi nt swel l ing

,and

d im in ished prespiration ,together wi th steady fal l ing

of pulse,the latter often qu ite slow w ith a sl ight

tendency to syncope, the major ity of the cases re

qu iring qu in ine,and supporting food about the s ixth

or seventh day,when convalesence advances rapidly.

The fol low ing i s a case ofact ive sthen ic type, occurr ing in a robust healthy woman .

CAS E I .— Mrs . J . C act. 40. On arri val at 8 am .

July 13 th,found the pat ient very hot and res tless

anx ious countenance ; suffused , swollenface con junc

ti vas deeplyi nj ected

,smart ing

,and accompan ied

w i th epiphora. Pulse full , bound ing, and about 100.

Almost every j oint much swollen knees, el bows,and wr ists

,in ten sly so. Not able to turn , or l ift up

i n bed pains very acute. Had ch i ll s and rigorsfor a day or two previous to v isi t ; sweat ing profusely . To have g i i i . of l ime j u ice every hour,n igh t and day.

J uly l 4th .— Pat ient general l y improved less

anx ious and restless pul se 805 face no longer

swol len,and red ; lachrymat ion ceas ing. Able to

move and turn . Jo int pain and swel l ing much less .Increased l ime j u ice to about 14 ounces dai ly.

July 15 th — St i ll improvi ng sl ight nausea discontinued l ime j u ice

,and ordered 'weak lemonade made

from fresh lemons. July l 6th.-Pat ient pale and

quiet al l pain and swell ing subs ided pulse slow

feels pretty weak ; to stop lemonade ; d iet, strongbeef tea

,eggs and mi lk to have qu in ine every two

hours,n ight and day . July l 7 th .

— S til l improv ingin every way ; to con t inue qu in ine, etc. July 20th.

Convalescing rapidly appet ite good,and tongue

clean to s i t up to-morrow.

CAS E I I. —February 28th .— R . B .

,set. 30. Had

been tak ing med icine from another phys ic ian some

days i l l fever st i l l pretty h igh tongue much fur

red . Wrists and knee-j o ints greatly swollen,and

suffering from fly ing pains in different parts ofthebody. Ordered 16 023. of l ime j u ice dai ly . March

2nd .— A great deal eas ier. S til l suffering more or

less from shoot ing pains ; but fever, swel l ing, andsweating subsided. March 3rd .

— D iscont inued l imej u ice

,and placed h im under colch icum

,bel ladonna

and carbonate of i ron ; beef tea, eggs an d m i lk .

March 7 th .— Convalescing rapidly

,and gain ing

st rength . To go out every day. Neuralgic pain,

66 THE CANADA LANCET.

almost ent irel y d isappeared. To cont inue p i l l s ofi ron and bel ladonna tw ice daily .

‘

CAS E I I I. —May 6th .— Thomas W .

,set. 19. Has

been i l lfor the past week fever not very h igh,but

j oin ts greatly swol len Weak confined to bedperspiring profusel y tongue coated. Ordered l im e

j u ice,16 oz s . dai ly . May 8th .

— Not much improved.

Increased the juice to 32 oz s. dai ly, as he bears i t wel land l ikes i t. To have an op ium p ill every n ight .May 12th .

— Swel l ing subs id ing rap idly,but n ot

en t irely gone. Tongue cleaner suffers s ti l l from al i ttle pain. N ight sweats d im in ishing. May 14th .

— Improv ing rap idly . To cont inue l ime j u ice,bu t

only as a weak lemonade prescribed qu in ine. In

the above case, the attack was sub-acute, but of a

decidedly asthen ic type, and I was in great doubtas to the benefit to be derived from the l ime j u icei n large doses ; however, by press ing i ts use

,and

carry ing i t up to two p ints dail y,al l the symptoms

rap idly van ished . D iet throughout consisted ofbeef tea, eggs and m i lk .

CAS E IV.— John N.

,set . 22. February 12th.

Acute rheumatism. Ful l pulse h ighfever jo intswel l ing and con stant profuse perspirat ion . O rder

ed l ime j u ice 20 ozs . dai ly . In th i s case there wasno particular feature Ofimportance

,beyond the fact

Of,

the rap idity of the act ion Ofthe l ime j u ice. The

disease was ent irely aborted, so to speak,in three

days. The fol low ing are the notes ofh i s cond i t ionon thefourth day . February l 6th.

— Pul se 82

tongue clean ing ; sweat ing sl ightly ; no th irst or

pain, but weak . Placed under qu in in e in full doses,

Th is pat ient convalesced rapidly,

The above cases extending over a period of fiveor six years, are taken at random

,from my note

bOok. These along w i th others,acute

,sub-acute and

chron ic have yi elded rap idly. to large doses of l imej u ice. I have had nofai lures w i th i t employed inth is way and offer these excerptsfor the cons iderat ion of my medical brethren

,w i th the ful lest assur

ance and confidence that they w i l l find in the j u icethus largely given— a veri table specificfor rheumat ic seiz ures.I should l ike to close th is paper w i th a ful l ac

count ofa most interest ing case of chron ic rheumati sm ,

in a young man ofth irty,but have

,unfortu

nately, m islaid the notes ofit. Suffice i t to say,

however, he had beenfor three years a martyr toi ntense suffering, laboring from t ime to t ime underacu te attacks. I found him confined to h is couch

,

a cr ipple and confirmed i nval id. Lime j u ice and

fresh lemon s were givenfreely for upwards of fiveweeks

,w i th a slow

,but sure and steady improve

ment . Being much debil i tated from the firs t, porterand qu in ine were given largel y throughout the treatm ent of h is case. When last seen , several months

subsequent to leav ing my hands,he had suffered no

relapses was very hearty and robus t in appearance,and in every way an al tered man. He had qu i terecovered from h is lameness

,no st iffness ofjoints

remain ing,save two or three fingers of on e hand

,

the latter due to a l i t t le permanent flexor contraet ion and th icken ing.

S ince wri t ing the above, I add the fol low ingnotes of a somewhat interestin g case j ust convalescing — G . D.

, set. 36 marri ed. Had an attack ofdiphtheria three weeks since

,from wh ich he rap idly

recovered under st imulants,followed

,Sept . 10th ,

by a severe seizure of erys ipelas ofthe left foot.For the latter he was given large doses of tinctureOfiron

,egg

-m ixture,beef-tea and qu in inefreely.

On the morn ing ofSept. 17 th he was attacked

w i th sharp pain,fol lowed by distress and soreness

in the region of the heart,for wh ich— deem ing the

symptoms as merely neuralgic in character— he was

given a full dose of bel ladonna and opi um comb ined.

Sept. 18th .— No better. Praecordial distress on

the increase,w i th decided fever

,ful l pulse

,and

rheumatic swel l ing i n knee and shoulder joints,both S ides tongue deeply furred

,and persp iring

profusely at n ight. He was placed at once underl ime-j u ice

,16 oz s . dai ly. D iet— as system has been

weakened by recen t i l lnesses— beef-tea,eggs and

m ilk and two ounces of brandy daily.Sept. l 9th.

— Heartfeels eas icr and throbs less,bu t no amel ioration of joint symptoms pulse weakand very qu ick .

Sept. 20th .— Swel l ing ofwrists and insteps , in

volv ing also the smal ler joints— fingers andboth hands

,too

,on dorsal aspect, '

very puffy ,len and red . P

constant th irs t. Doubled the dose2 p ints daily

,by measurement.

Sept. 21st.— More plac id ; pulse 100 sleptbetween every dose of the medicine

,the first

for the past three n ights swell ing of al l the jsubsiding n igh t sweats and thi rst decl in ing.

THE CANADA LANCET.

were sl igh tly re laxed . To ‘cont inue beef-tea,egg

mi x t ure and st imulants.Sept . 22md — R educed the l ime-j u ice, as he i s

much improved, to 16 ounces daily. Patient a l i t

tle weaker, but otherwi se improved pulse 100.

Sept. 23rd .— S topped the l ime-j uice puls e 104

,

weak and compress ible. Sweats st ill a good deal at

n ight,but attributed to general nervous debi l ity ;

placed under quin ine, in 1k gr. doses every twohours n ig ht and day.

Sept. 25 th .—Convalesc ing able to get out of

bed into an easy chai r w ithout ass istance tongueclean ing rap idly ; heart sounds normal .The above case presents some points of cons idera

ble i nterest,and shows what support ing treatment

wil l do in maintain in g the system under try ing cirThree sharp attacks Of as many ai l

ments , occurri ng w ith in a period of five weeks, issufficient to tax the powers of any nervous system .

It w il l be observed the pulse ran h igh al l th roughh is last affl ict ion . Th is may doubtless be attr ibutedin part to the d isease havi ng spent cons iderable ofi ts force on the heart

,to the general debil ity ofthe

pati ent from causes al ready referred to,and to hi s

natural ly h igh pulse— about 90 being i ts healthystandard. The very

, larg e doses of therequ is ite i n conquer in g the attack

,is also interest

est ing. W i thout i t the heart would,in all proba

b i l i ty, have fared badly.In conclus ion , let m e enjoin the absolute neces

sity of us ing only pure j ui ce, and, when there i sany doubt— ofObta in ingfresh lemons . The latter

mus t, of course, be gi ven i n abundance, sufficien t tofurn ish the equ ivalent of n ot less than 12 ounces ofl ime-juice dai l y.

CANCER OFTHE STOMACH.

BY G. B. MOT’I‘, M.D.,

PETR OLIA,ONT.

J . C . H ., set. 65 , cal led at my Office on the 27 th

of May , 187 6 . He complained Ofd ifficulty inswallow ing, w i th pain and t enderness over theregion of the stomach and a constant des ire to eructate but ow ing to a supposed stricture, eructat ionwas imposs ible. He had been treated for dyspeps iaand a variety Ofstomach d iseases

,but .w i th sl ight

temporary rel ief. Upon enqu iry,I learned that he

had experienced more or less pain in the ne ighbourhood ofthe stomachfor the las tfive years

,and had

suffered from habi tual costiveness nearly al l h is l ife.

‘

He was born in Vermont , U. S .,and when qu ite

young,em igrated w i th h i s parents , to Canada, where

he remained up to the t ime of h i s death .Fam i l yh istory good

,hav ing no t race of scrofula father

died set. 65from pneumon ia ; mother at 95, fromapoplexy hab its strictly temperate ; has been en

gaged i n the oi l busi nessfor the last twel ve years inPetrol ia. From a thorough phys ical examinat ionand the h istory of h is case

,I d iagnosed cancer of

the stomach,wh ich was received w i th aston ishment

and doubt by my pat ient.I appl ied t incture of bel ladonna over the stomach

once a day and ordered h im l ime water and m i lkbeef tea and oyster soup to be takenfrequen tly and

in smal l quant i t ies,wh ich was continued up to the

12th of June, after wh ich I lost track ofh im unt ilthe l st of October

,when I was sent for to v is it h im

at.

h i s res idence. I learned that he had been under

Homoeopath ic treatment dur ing the interval , w i thsl ight occas ional temporary rel ief. H is cond i tion

was much worse,all the previ ous symptoms being

aggravated,w ith oedema of the lower ex trem i t ies.

He urged me to do someth ingfor h im. I refused

to at tend h im w i thout consul tat ion , in wh ich mypat ient acqu iesced; and Dr. Edwards, of S trathroy,was sentfor . He ful ly coincided w i th my d iagnosIs,and thefol low ing treatmen t was agreed upon

R — B ismuthi S ubn i t. ,Pulv. Ipecac. ,S odse B icarb ,

D iv. in chart ., No. y uj .

S IG .— O ne to be taken every three hours.

R — Strychn ias , gr. j .As . Pun . 3 vj . - M .

S IG .— A teaspoonful three t imes a day .

Counter-irri tat ion was Ordered over the stomach

with bel ladonna, iod ine and mustard, as requ ired toallay irri tat ion of that organ . Under th i s treatment

some improvement took place in h is symptoms,whi ch

,however. was of short durat ion . He re

mained in about the same state up to the 20th OfNovember

,when he was seized w ith paralys is, from

wh ich he part ial l y recovered,death tak ing place on

the 30th . I m ight here state that the stricture, Ofwh ich he complained so much , gave way about th reedays before he was taken w i th paralys is, wh ich enabled h im to swal low w i thout any d iffi culty.

Au top sy, twelve hours after death in presence ofDrs . Edwards, Henderson and Stevenson ofS trath

THE CANADA LANCET.

roy , Lougheed of Petro l ia, and afew friends of deceased. An Incis ion was made from the top of the

s ternum to the pub is, through the integument the

s ternum was separatedfrom the costal cart ilages andremoved

,exposing the lungs, the upper lobes Of

Which werefound to be adherent to the walls of thechest

,but otherw ise heal thy w i th the except ion of

pigmentary deposi t. Heart,pericard ium and spleen

healthy ; several large depos its of melanot ic cancer inthe l iver and k idneys. The card iac ori fice and lessercurvature of the stomach were involved. The pan

creas appeared to have been the start ing point of thed isease as that organ was a complete mass of adhes ion . An incision was made into the s tomach

,and

a large clot ofblood, the s ize of a man’s closed hand,Was discovered. The difficul ty in swallow ing comp lained of so much by the pat ient was caused by acancerous tumor in the oesophageal opening of the

s tomach , wh ich had dropped downward by reasonOfi ts weight, and no doubt was the cause of the re

l ief i n swal low ing wh ich took place two weeks priorto death . It was thought unnecessary to exam inethe brain

,as the cause of death was qu i te ev ident

from the examination j ust made .

The above case i s not only a very interest ing, butalso an instructive on e, especially as the moreprom inent symptoms of true cancer , as gi ven by theb est authors, were absent, such as vom iting and thepass ing of blood and matter w ith the stools. The

patient inform ed me that he never was sick at h is

stomach , much less to vom it. Most authors regard

vom i t ing as a pathognomon ic symptom of cancer ofthe stomach .

H ER NIA— THE AUTHOR S WHO WR OTEON IT— AND ITS TR EATMENT PR IORTO THE 1 8TH CENTUR Y.

BY J. R. ALEXANDER, M .D.,MONTREAL

In the l imits ofth e present article i t will beimposs ible to enter very fully into all the authors’views , or even to give all their names, neither wil lI take the space necessary to menti on th e works

from which most of i t has been tak en , but will,as briefly as possibl e give the principal means

(xxi . chap . ) 1 7 , s oth verses, where the command Is given : Speak unto Aaron

,saying

,who

soever he be ofthy seed in their generation,that

hath any blemish , l et h im not approach to offerthe bread of his God, and then the blemishes are

enumerated, and I bel ieve that hernia is one of

them . Between the time of Pythagoras and the

Peloponnesian war, philosophy and physio madesuch rapid progress that it was deemed necessary

to d ivide them . But it is to Hippocrates that

must be given the honor ofthe division ofPhysicinto Medicine and S urgery

,each branch having

much more than any man can possibly master inthe longest and most studious l ifetime

,and if th is

natural division had been followed,and even sub

d ivd ed , how much better it would have beenfor allinterested ? He was the first who gave anything l ike

a correct account of the d iseases ofhis age,and

he was the firs t who described hernia and although

not technically accurate as we understand it, nodoubt it was substantial ly correctfor the age in

which he l ived. I t was less frequent in that age

than at present,with our art ificial and hot-bed

diseased society.

Fol lowing H ippocrates we have hernia describedby Meges, Georgias, Heron, and S oftratus, but bynone ofthese is given any definite treatmen t forthis affect ion . During the reign Ofthe EmperorsAugustus and Tiberius

,Celsus described most

accurately, hernia Of th e groin and scrotum . H e

gives the manner Of Operating in h is time in

hernia. The surgeon Opened the Scrotum,took

hold Of the sac, and after he had returned the

intestine, cu t i t offthen be t ied the spermatic cordand removed the testicle. He cu t out part ofth escrotum and t e-united the l ips

,to form a sol id

cicatrix that would prevent the fall ing down ofth eparts. In the time OfAntoninus

,Galen and some

of his successors described these diseases moreaccurately than. was done before. Oribasius

,fEtius, but m ore

‘

particularly Paulus n inetus,

who l ived in the seventh century Ofth e Christ ianera, omitted nothing which pertained to themethod of treat ing hernia in h is time

,wh ich varied

somewhat from that practised by Celsus,because

Constantine, the firs t Christian Emperor,who no

adopted with a view to cure hernia, reserving for doubt saw i ts evi l effects in h is empire, enforced aanother time some minor considerations .The firs t allusion to hern ia, although not de tes ticle.

law against th e treatment by the removal Of theThe only C hange introduced by ,

Pau lus

finitely mentioned, is to be‘

found in "

Levit icus [ Eginetus in the Celsus operation , was the tying o f

THE CANADA LANCET.

the sac and cutting it offbelow the ligature . Up

to the latter part ofth e seventen th centu ry, the

principal writers (not already referred to) wereAlbucasis

,R oger de Parma

,Guy de Chauliac,

Lafranc,Franco

,Benedictus Pare , theFabricu,

Brechet, Bartholinus , Fal lopius, Albenus , Vesal iu s,Berault

,Scul tetus

, &c., &c. Albucas is gives an

o ther method OfOperating, or rather torturing, inwhich the testicle is not treated with any more re

gard. He applied the actual cautery to the Open

ing through wh ich th e intestine protruded , and leti t penetrate to the bone

,so that the bone and

the scro tum may be united closely together. R O

ger de Parma did not spare th e tes ticle ei ther; he

took a large needle, threaded wi th twisted thread,and passed i t through the th ickest part ofth escrotum below the spermatic vessel s , he then

placed some hard subs tance on the top Of the

scrotum and tigh tened the thread every day. Manyfavoured this mode Oftreatment. Lafranc

,appar

ently wishing to be more cr uel than others,if pos

sibl e, appl ied a large pair ofpincers, with sl its inthem

,through which he ran a red hot sharp knife

to cauteriz e the os pubis. Guy de Chaul iac madeuse ofcaustic to burn the ring and sac

,and pre*

ended not to injure the spermatic cord . Berault

used gold wire first the rupture was reduced,and

the sac opened; he then passed a gold wire through

i t near th e ring four times , then twi s ted the endstightly together

,and carefully dressed the wound.

Franco and many others Operated in the same way,

but made use Of common wire,and even lead.

The removal Of the testicle for the cure of

hernia became quite common,especially in chil

dren , so that in Holland a law was passed agains t

i t, and in the beg inning ofth e eigh teenth centu rya law was passed against it in Fran ce

, one woman

alone having castrated five hundred children .

The Prince ofMoldavia,in h is h istory ofth e

O ttoman Empire,says that th e inhabitan ts ofAl

bania and Epirus excel in th e cure ofhernia,and

he then descr ibes the process which ' h e Observed

as follows As to the cure Of hernia,they under

take i t upon al l sorts ofpeople , and ofall ages.Their method is very coarse

,but yet successful .

When I was at Constan tinople I had the operat ion

performed upon my secretary who was an elderlyman , in my Own palace. Having agreed as tothe expense, they tied the patient down to a board ,and secured him firmly from his chest down to

his feet with s trong bandages ; then the operator

made an in cision in th e lower part ofth e abdomenwith a sharp knife. The peri toneum being open

ed , he pulled Out about the bulk ofa hand of thein ternal substance under the skin , then drew up

the intestine,which was in the scrotum

,into i ts

proper place . Afterwards he sewed up the periton eum with very strong thread , which had a knot

at the end to prevent i t from slipping ; and thenth e l ips which hung over were cut offwith thesame instrument. The wound was rubbed withhog

’s fat and cauteriz ed with a red-hot iron . B e

fore the dressing was applied th ey l ifted up th e

legs Of the patient,who was nearly dead

,and poured

the white of n ine new-laid eggs into the wound

and if that liquor fermented and bubbled with in

the space of an hour or two,i t was a certain sign

of cure. On the con trary, if there was no appearance of that kind in three hours

,they considered

i t unfavorable and promised noth ing. They always

attributed Il l-success to the age or weakness ofth epatien t

,for they have no doubts ofth e efficacy of

their method ; and indeed there seldom die two

out ofon e hundred of those whom they undertake .After two or three days they repeat the use of th e

white ofeggs and all th is time the patien t is keptextended upon the back

,without giving any signs

ofl ife, or having very much sensibil i ty. The

Operators d id not suffer h im to take any thing ;but thought i t sufficien t to moisten th e tonguefrom time to time w i th a l i ttl e water. The fourth

day th ey took him out ofbed, stil l secured to th eboard

,when he came to h imself

,and with a feebl e

vo ice complained of h is pains . They gave him

three or four spoonfuls of warm water to quiet

h im,and the three following days

,broth s were

given to h im sparingly,but h e was not al lowed to

touch sol idfood. On the seventh day he was nut ied and pu t to bed, but was watched to preven t

his turning on his side or stirring his legs . Every

day the appl ication Of th e white of eggs was renewed

,but from the n in th to the twel fth day

,on ly

six were applied, and as soon as they were poured

on the wound they fermented more than they

ever did before. The wh i te of a single egg couldscarcely be admitted on the fifteenth day

,bu t i t

was continued wh ils t any would enter,and th ere

was the least appearance Offermentation . As

soon as fermentat ion was over, the wound wascovered with a plaster made ofpitch and O i l, then

-70 ‘THE CANADA LANCET.

.thepat i ent was allowed to s t i r .hIs feet and to . l i c ON STR ABISMUS AND ITS OPER ATION.

‘On h i s S i de. Every morn i ng the thread was pulled

to see if the l igature could be removed, which de BY ADOLF ALT, M .D .; TORONTO .

p ended o n th e s trength of the pat ient. Somew ere cured in .twenty

,others thirty

,and others Late R ea der“ and AS S ‘S ta’lt S ‘lrgeon and L‘T-C turer on

Normal and Pathological Histology ofthe Eye and Ear“forty days It was consi dered a cure when the

16 the N. Y , ophthalm ic and Aural Institute.

thread was removed and a second plaster appl iedto complete th e heal ing.

”H e then Here Strabismus, especial ly convergent (hyperopic)

w e see -a surprising Operation,ofwhich T was strabismus, seem s to .be a . c0mparatively frequent

an eye witness,and which is practised with suc disease in th is country, and ne i ther the necessity

c ess, by“a savage people

,ignorant -ofscience .

”nor the feas ibility ofi ts Operation seem to be

That wh ich will strike the careful observer mos t rightly appreciated. In countries where every

forcibly in the foregoing wi l l be the great bar student ofmedicine i s forced to study ophthalmo

barity in the means employed by all , which had logy, as wel l as all the other branches ofmedicali n view t he same end , v iz .

,the C losing up ofthe science , (as in Germany and France , ) and where

opening through which the parts protruded , and Ophthalmic surgery is an often chosen . special ty,

at the same time h e must have been led to th ink the frequency Of strabismus has been . greatly re

that if as much time and talen t had been spent d uced , s ince every pract i tioner is aware , ofi tsto devise some mechanical means ofsupport, serious consequences , and knows that its cure ishaving in view-the end des ired— a radical c ure

,comparatively easily accompl ished. This . i s an .

as was wasted to contrive means Of torture,there importantfact, as i t l ies mostly in the hands of

would have existed at the beginn ing of the the fam i ly phys ician , .whether parents consent to

e igh teenth century someth ing worthy ofthe name have their children operated upon or not, andoftru ss or support. 1 5 i t not -astonishing that only the lack of familiarity w ith the subj ect cant here was no defin ite mode Of treatment ? That excuse the advice so often given “ that it i s nott here was not -is an undisputed fact

,but if we necessary to Operate” “ that the ch i ld will outgrow

wonder that there was no establ ished principles i t,” etc. That a conscientious phys ician w il l notfor the treatment of hernia

,the most frequent act so , if he knows .better

, . i s plain and i t thered isease to which the human family was subj ect

,fore may be ofinterest to bring some of the lead

at the end ofthe seventeenth century,should we ing points on this frequent d isease

,before the gen

n ot be overwhelmed with aston ishment when we eral practi tioner.consider the fact, that now, near the close Of the There are two kinds ofsquinting which mustn ineteenth century

,there are yet no fixed rules be dist inguished

,paralytic and muscular strabi s

for the treatm en t and cure ofhernia. I am n ot mus . The former is the rarer form . I t is disnow speaking ofoperations, or ofstrangulated tingui shed by double images, and caused by parh ernia, or old -cases oftwenty or thirty years’ es is or paralysis ofon e or more of the s ix muss tanding, which should have been cured long cle‘s Of the eyeball . In

.

the latter— the muscularago , Where

'

the muscles and tendons are all re strabismus— th e two opposite m uscles do not actlaxed and wasted away by the pressure ofbad with equal force

,and therefore the stronger one

fi tt ing trusses, and whe n the Opening has become pulls the eye towards that s ide. This i s caused byvery large , but I am speak ing of those who are the relaxation of one m uscle , and hyper-retractionrecently ruptured, and who go to the surgeon for ofi ts opponent, or an abnormal insertion ofonetreatment. They will be told, Oh, i t is noth ing, of them upon the sclerotic, either too far forwardj ust go and get a truss and wear it; but you need or too far backward. III cases ofmuscular strabnever expect to be cured. There is no doubt ismus the motility towards th e side ofth e weakerthat many cases ofhernia can be cured

,and muscle (or the on e inserted farther backward) , is

that with comparative ease and certainty,by a only restricted

,no t totally wanting, as i s mostly

proper mechan ical contrivance and hence the the case in paralyt ic strab ismus,and is abnormally

greatest possibl e care should be taken in the large towards the opposite side. The patien t

selection ofa s'uitable truss. may squint with one geye only— th is is the mos t

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7 2 THE CANADA LANG ET.

THE TYR ANNY

'

OFAFALSE SENTIMENT.

To the Edi tor ofthe CANADA LANCET.S ue— The interdict ion is not to be found, at

leas t not directly and plainly, in our code of eth ics,but some how that code i s und erstood to erectnumerous barriers between the publ ic and members ofthe profession— I refer to th e relations ofcommon ci tiz enship. To a certain extent that isrigh t and proper, inasmuch as i t tends to keepmen more or less unscrupulous as to the use ofmeans

,

from bringing themselves into publ ic notice . N0

one having regard for the dignity of the professionwill deny that safe-guard s are necessary, ofa moreor l ess stringent character, the transgress ion ofwhich w il l bring swift and certain odium upon thetransgressor.While fully and freely conceding all this

,w ithin

reasonable bounds , and I suppose no one claims

more,yet for a long time I have been of the bel ief,

that th e ve ry existence ofsuch safe guards— as und erstood and interpreted- that the knowledge that

their private and publ ic acts are watched with an

argus eye,and a j ealous suspicion

,has

,in a very

large measure,served to curtail the usefulnesss of

medical men as members of the commun i ty inwhich tl‘ ey l ive . They feel themselves surrounded

by barriers— they feel cramped,burdened

,and not

at l iberty l ike o ther men to act naturally. I f i t canbe shewn that thi s is the posi tion occupied bymedical men

,and I th ink it can

,i t must be con

fessed i t is a humilia ting one.

The code of eth ics proh ib its al l newspaper cards,

but i t says noth ing against a medical man writinga series of letters to a newspaper on topics imme

diately or remotely identified with medical science,

yet by tac it understanding, such an act, howevermuch in the publ ic interest

,is regarded as unprofess ional. Many gen tlemen in our ranks could

edit a department in the local paper greatly to theprofi t of the commun i ty

,bu t the censors say no

such conduct is simply a bidfor publ ic favor,they

allege, and if the crime is persis ted in , the med icalpress, and the county society, will hurl their male '

dictions at the offender’s devoted head,and for

ever after brand h im as an outcast. O r it may be,

that after many m isgivings,and much fear and’

trembling, an able member has ventured to comeout ofthe shell ofwhich he is an unwill ing occup an t, for the purpose ofaddressing his fellows

vi tal publ ic imphealth and l ife.t ising h i s wares,law. Some jeal

get a part of h isplain t to the Lancet

,or formulates charges at the

ensuing meeting of the local society,and generally,

such a storm is raised,that the able and d isim~

terested member resolves never again to appear on ,

a publ ic platform. These th ings do not very oftenoccur in Me Id ler , but in sp i r i t they are da ily andhourly occurring . Men who could instruct and

ed ify the publ ic, refrain from using thei r talentsforfear ofarousing j ealousy and il l-feel ing amongsttheir local brethren

,and call ing forth the anathe

mas of the medical press and th e societies.Let me give an il lustrat ion of the evil spirit

wh ich pervades the profess ion in this regard,

especially in country places . Afew years ago twomedical men resided in one ofour v il lages . The

first to locate there fancied,he had a proprietary ”

right to the whole field , as is usual , and was determined to keep at bay al l intruders on his vested

rights . He d id n ot,however

,up to the t ime to

which I am going to refer, refuse to interchangewith the new comer

,a cold

,How do you do .

”

He was no speaker, wh i le the n ew man could

make a few passable remarks in publ ic . Somepubl ic gathering was about to take place

,th e na

ture of which seemed to render i t probable that

both these gentlemen would be call ed to their feet.

In the mean time the doctors chanced to meet,

and it was alleged, that resident number one, ex~torted from number two a promise n ot to speak .

The gath ering came off,but after all

,for some

reason , number two made a short speech . Therenever had been much cord ial ity

,bu t on that day

war was proclaimed to the bitter end, wh ich has probably continued to the present t ime. Just fancytwo sensible men in any other sphere of l ife dis

playing j ealou sy and vind ictiveness under similarcircumstances Why cannot medical men l ive asharmon iously as the lawyers P I s i t not a fact thatour j ealous ies and crotchets are standing jokes

amongst members of other professions ?Here we have powerful elements at work to

dwarf and snuffout the intellectual forces oftheprofession

,instead of giving them free play and

encouragement. I bel ieve there is as much , if not

THE CANADA LANCET.

ething wrong— someth ing

Medical men ofknownged to come ou t , and let

efit of what th ey know of

o r lawyer, be looked upon with jaundiced eyes , or

as advertis ing his wares should he see fi t and pro

per to deliver a publ ic lecture,for example

,on the

popular and importan t subj ect ofpure air in relati on to heal th ? O r, why is not a doctor equallyat l iberty with other men to write for th e papersand manfully assume the responsibil ity ofwhat h ewri tes by appending h is name P There is no great

reason that I can discover,and i t is abou t time

the profession were rel ieved ofthis mean,dwarfing

and annoying tyranny.

Mark, I am not contending for the l iberty ofw ri ting up diseases and call ing atten tion to modes

oftreatment, or anything ofthat k ind. That

would be charlatin ism in one ofi ts wors t forms.What I claim is, our code ofeth ics, good enoughi t may be in itself, should be so interpreted bythe medical press and the profession as to give

rise to a manly and heal thy sentiment in regard to

the matters of complaint,that members of the pro

fession may go out amongst their fel low men asted gentlemen in other

ofcourse , arises fromus ies , unworthy ofmen occupying themembers ofan honorable and learned October l 0th , 1 8 7 7

but the evils complained ofare renderore burdensome and harassing by a

7 3

ANTI-H U MBUG.

CR IM INAL DIS S EC ’

I‘

ION.— The House Surgeon of

the Glasgow Maternity Hospital was arrested forviolating the Anatomy Act, in dissecting the deadbody ofan infant aga inst the expressed wish of itsmother.

iberal ity pervad ing the profession , hav

divines , and speeches by great lawyers. Such

reports are often accompanied by eulogiums upon

th e eloquence and abil i ty displayed. With all

this, no one finds faul t— not even medical men.

I t is admitted that it is al l right and proper,and

not in the leas t degree derogatory to the d ignityofeither profession . Both the divine and the

lawyer, le t i t be observed, are spoken ofas acting wi thin th e l im its oftheir respective callings .Now let Dr. Somebody be called to a case ofinj ury by accident

,or l e t h im perform a brill ian t

operation and save a valuable l ife, and let the

matter be reported in th e press, and behold what

a change ofsent iment I t is al l rightfor the mini ster or lawyer, but for th e press to treat a medica l

man in that way is simply ou trageous,and the

poor editor must be soundly ratedfor allowingsuch matters to find a place in his columns .

Great lawyers bel ieve in publ ish ing their bu siness

cards,but doctors are forbidden to do so because

,

forsooth,such a practice is “ derogatory to the

digni ty ofth e profession.

” The fact that th is

prohibition is practically ignored by hundreds ofour best men is the best proof of its absurdity .

Let it n ot be understood that I am advocating a

general sys tem of ad vertis ing— not by any means ;but I contend that we have no righ t to become

censors ofth e press, nor in any way interfere withth e rights ofeditors so long as our own righ ts arenot infringed upon . Moreover

,I claim for medica l

men th e same immunity from censure and s zzsp z'

a’

on

that is enj oyed by members ofthe other learnedprofessions. I bel ieve the practical adopti on ofth ese views would greatly tend to promote the

growth of manly independence,th e developmen t

oftalent,and the general usefulness ofmedical

men in the communities in which th ey l ive.

The importance of the subj ect is my only

excuse for the undue length of th is commun ica

tion . Your own views,Mr. Editor, on some of

the points raised,I am convinced would prove

ofgeneral in terest to the profess ion

THE CANADA LANCET.

firtrrtrd g rtirlra.

VASELINE AND SALICYLIC AC ID IN

OBSTETR ICS.

In a recen t number ofth e Medical R ecord Icalled atten tion to the use ofvasel ine and sal icylicacid in th e heal ing ofwounds ; in the present Ipropose briefly to mention some ofth e variousu ses for which this compound seems adapted .

Vasel ine,is a hydrocarbon made from petroleum

by s imple evaporation and clarification . I t isvery cheap , be ing worth on ly some forty to fiftycents a pound . I t has no taste or smell . I tsrole as a protective against the action ofthe airis ex tensive , as in burns, excoriations . etc. I t i son e ofthe best oflubricants. I ts use is simpleand especially in complicated labors i s thus veryadvantageous . In ternal ly, i t seems to rel ieveirritation ofth e mucous membrane

,and

,when

taken up by the system , though it undergoes noproper digestion , to act much in the same way as

cod -l iver oi l . As a vehicle for more active agen ts,

i t i s more general ly useful than any other o i l-l ikecompound. Salicyl ic acid has oflate come intovogue

,and is now used for a great variety of pur

poses— principally as an antiseptic,to reduce the

heat ofthe body, and in diseases in which there isa morbid material in the blood

,as in rheumatism

and gout,etc. I t is n ot expensive

,costing from

th irty to forty cents an ounce . I have tried severalsamples ofd ifferent manufacture, and find that ofR ossengarten , of Philadelphia, by far the best,wh il e the German article that I have used hasproved caustic and utterly unfi tfor many purposes .The American acid is in silky

,white crystals

,l ike

qu inine , has no caustic tas te , and, m ixed withvasel ine, makes a homogenous oin tment. TheGerman is amorphous , looks l ike chalk , has aslight pinkish color and caustic taste

,and

,mixed

with vasel ine , makes a lumpy , irri tating ointment,unfit for use.

With these few prel iminary remarks,I will now

briefly notice some ofthe many uses ofthese twovaluable agents and firs t as to the ir use inobstetrics. I t has been my practicefor some timeback to use vasel ine , with a grain or more ofsalicylic acid to the ounce , and scented with a dropofottar ofroses, in al l vaginal examinations, instead ofoi l or soap . I bel ieve I thereby morecertainly avoid carrying infection from case to .

case than I should otherwise do. In first confin emeri ts i t may be used in the first state ofthe labor,so soon as the woman takes to bed . I mak e useofa glass syringe, an inch in diameter without anozz le . W i th an instrumen t ofthis kind an ounceor more of the semi-sol id vaseline can be introduced up to the 05 , where it remains at the temper

ature of the body , in a semi-solid state. I use itin th is way as a simple lubricant

,and withou t the

addition ofthe acid. I f desirable,in certain cases

,

i t can be combined w i th the extract ofbelladonna,and , after the labor is completed , with the extractofergot, or, in case of hemorrhage , with the l iq.

ferri persulphatis,w i th all of which i t mixes wel l.I f i t i s des ired to introduce i t into th e u terus

,i t

can be rendered flu id by putting the bottle con

taining it into water ofa temperature of1 00°F.,when i t can be used with the ordinary uterinesyringe . In th e course ofa labor I u se three to

s ix ounces, with th e effect , as I claim , ofshortening the first stage oflabor and rendering the partsespecially in first labors

,easily dilatable in the

second stage,while

,after th e placenta IS delivered ,

a small quantity of the vasel ine, with the acidadded , d isinfects the discharges , and does much ,i t seems to m e, to prevent purulen t absorption .

Indeed,if puerperal fever was prevalen t

,I should

not hesitate to introduce it freely into the uteru simmed iately after confinement . To illustrate thehealing qual i ties of th is comb ination , I some timeago had an extensive rupture ofthe perineum in aprimipara

,due to an unusually large child and to

an unyield ing perineum . I passed two pin sthrough the l ips ofthe wound and a figure-of-e ightaround each

,and directed the patien t to introduce

a l ittle ofthe vasel ine ointment two or three t imesa day on her finger. On the third day after, whenI next saw her on removing the p ins I found thewound ent irely h ealed . My cases are not sufficien t to base pos it ive conclus ions on

,but I am in

cl ined to tbinb t/zat an boar or more can be savea i n

an ord ina iy labor by t/ze use ofti le vaseline, and thatt/ze second stage w i ll go on eas ier ow i ing to a mor e

tlzor ongb r elaxation ofthe soft par ts , and to the

avoidance ofun necessaryfr iction ,and t/zat i ts use

w i tb tbc acid after labor w i ll do mucli to p reven t

p uerperal absorp tion ,and

,i n any even t

,w i ll condzcce

to tbe comfor t ofthe patient . In dilat ing the os

with the sponge tent,I find that by coating i t wi th

th e vaseline and the acid , ( ten grs. to the ounce) , Ican more read ily introduce it, the ten t not expanding at first

,owing to the coating of vaseline but

,if heldfor a moment or two in place , i t will remainwithout danger ofi ts coming away, and will expand to the same limi ts that i t would have donewithout the coating of v asel ine, as can easi ly beproved by putting two tents 111 water, one coatedand the other not. In erosions ofthe 05 , after theengorgement ofth e parts is removed by glycerinepads

,the vaseline and acid ointment, appl ied on

cotton-wool,wil l do much to effect a speedy cure,

espec ially if alternated with the glycerine . Thereis on e use for this ointment that I have not fullyworked out. Phys icians are frequently applied ‘

to,to produce abort ion . R ecently, 011 the same

day,two women came to me ; the reason assignedin the one case was that the husband was syphi li

THE CANADA LANCET.

bu t it was al l that I could do to preven tthese cases from going to a professedist. In some cases ofthis kind preven tionthan cure

,and I am incl ined to th ink ,

me experiments,that vasel ine, charged

r to five grains ofsal icyl ic acid , will desinj ury to the u teru s or

a number ofuses fornursery. I makebu t i t is a great

is extensive . Thegfor the umbil ica lthan oi l or soap to

remove the cerumen from the n ewly-born infant.Mixed with an equal weight of honey and ten grs .ofborax or ofchlorate ofpotassa to the ounce, i tanswers an excel len t purpose in case ofth rush .

The ointment [ alone, or mixed with ten grs . of

quinine to th e ounce qu ickly removes th e smallworms that frequently in fest the anus ofyoung

,children . In the excoriations of infants i t effectsrapid heal ing. In th e not uncommon sore eyes ofthe firs t few days ofl ife the vaseline alone in troduced within the eyel ids , effects a cure in a day ortwo. Again

,in the sn uffles ofthe old women ,

which,by preventing nurs ing, frequently seriously

effect the health ofthe infant, i t, when in troducedinto the nostr i ls with a camel’s-hair pencil , answersbetter than anyth ing I have as yet tried, espec iallyi f the head is kept warm with a flannel cap .

There are many other usesfor vaseline, alone or

varying proportion s ofsal icyl icphysician will readee tion . There yetof the uses ofthesemedicine

,which in

a future number ofth is j ournal, I will b riefly referto .

-D r . D uboi’

s,Med . R ecord .

CLINIC BY PR OF. LOOMIS, NEW YOR K .

C IRRHOS I S OFTHE L IVER.

The history ofth e case is as follows : The patien tage

,a well-buil t and powerful . man ,y of an uneasy sensation andthe region ofth e stomach .

7 5

VALVU LAR LES ION OFTHE HEART.

The case before u s has th e following historyThe man is thirty years ofage , and says that hecomes here because h e has disease of the h eart.When asked why he thinks he has d isease of th eh eart

,he repl ies by saying : “ Because he feels a

pulsation in the region of the heart ; in oth erwords

,he had been consciou s ofhaving had a

heart during the las t twelve years. Twelve yearsago

,or a l ittle more, he had his first attack of

acute articular rheumatism,and was sick in bed

three or four month s. He has had seven or eigh tattacks since

,and each one has las ted for some

t ime,one continu ing for over six month s before

there was any marked improvement .The first th ing that attracted the patient’s

‘

at

however,th is distention entirely disap pears. No

tumor can be fel t,there is no dulness upon per

cussion,bu t on the con trary there i s marked

tympani ti c resonance over the region ofthe stomach as well as over the entire abdomen . Percuss ion over the region ofthe l iver reveals the factthat th e arc ofnormal hepatic dulness is very muchdiminished .

C ommen ts — The fact that th is man has been adrinker of alcohol for a long time, that he has gascous distention ofth e stomach and bowel s , andthat there is marked diminution in the siz e ofth el iver

,leads us to the conclusion that h e has

cirrhosis ofthe l iver, and that the symptoms ofwhich he complains are dependen t upon gastriccatarrh . Such a disten tion ofthe s tomach and infest ines is perhaps the earl iest symptoms ofcirrhos is ofth e l iver ; i t appears before vomiting ofblood

,hemorrhage from the bowels, before any

noticeable change in the siz e of the organ indeed ,before any ofthe usual symptoms of that affection .

Treatnzen t.— The only th ing to be done, as faras the l iver is concerned

,in the way oftreatment,

is to stop taking alcohol . For th e gastric catarrh ,after s topping the use of alcohol , i t i s important t oregulate the diet

,being careful that only so much

food is taken as can be retained , and of such kindas wil l be least l iable to offend the stomach . Sucha regulation ofdiet must be rigidly adhered to i fthe gastric catarrh i s to be controlled . I f th epatient is will ing to submit to the rigid rules re

quired with reference to diet and abstaining fromthe use ofalcohol , improvement may be expected .

As soon as food can be received w ithou t beingrej ected

,there is nothing which is so effectual in

correcting this gaseous distension ofth e stomachand intestines as nux vomica . A prescriptionwhich I very commonly employ in these cases ofrum stomach consists ofequal parts ofthe com

pound tincture ofgentian and columbo, with fromfive to fifteen drops of the tincture ofnux vomicain each dose

,and taken before meals. An occasi

onal aloetic and mercurial purge will al so be beneficial .

THE CANADA LAN JET.

tention towards his heart was the palpitation, or

“p ulsation ,

” and it became so annoying that i t interfered with his work . When he turned around

q u ickly a kind of diz z iness came over him . Hehas been steadily growing worse with reference toth ese symptoms

,bu t more particularly during the

last two years. Of late there has been increasedd i sturbance ofthe action ofth e heart, and he hassuffered from vertigo more than usual . He knowsofno special reason why his symptoms shouldhave increased particularly during the last twoyears, unless i t was due to the fact of his havinghad an attack ofrheumatism about two years ago.W i th in th is time, however, he has had ch ills andfever

,

” and,wh ile s ick

,his heart troubled him very

much,and has cont inued to trouble h im more than

before since that attack,especially on going up

sta irs; He has had swell ing of both feet, theoedema, however, extending no higher than theankles. He has not had any d isturbance ofthestomach 110 d isturbance ofvision , except transientand in connection with the vertigo and has neverhad cough and expectoration . His pulse is regular

,and has a sl ight jerki1.g character.C ommen ts .

—From the h istory ofthe case alone,

i t is qu ite probable that th is man has organicles ion affecting the aortic valves . The reasonsforsuspecting that condit ion are

,that he has had

frequent attacks of vertigo,which rarely accompan

i es mitral lesion . Th is symptom almost alwaysaccompanies aortic lesion when there is considerable hypertrophy ofthe left ventri cle. Again

,he

has not had cough and expectoration,a fact which

points to aortic rather than mitral l esion . For, am itral lesion continu ing twelve years wi thout someevidence ofbronchitis, would be rare. One goodreason for suspecting that i t might be a m itrallesion

,i s the fact that it was developed while

young. H is pulse is not characteristic ofe i theraortic or mitral d isease. So far then as the historycan assis t us , i t favors aortic lesion , and we willnow determine by physical examination Whetherour suspic ion is well founded.

R EMOVAL OF MECKEL’S G ANG LIONFORFACIAL NEU R ALG IA.

P liy s ical Exam ination .— O u inspection , i t wil l be

seen that his countenance does not indicate a verygreat deal ofsuffering. I t wil l al so be noticedthat there is an increased area of the apex beat

,

and that i t is carried to the left and as high as thefourth rib there is al so a sligh t pulsat ion ofthecarotids. Upon palpati on ,

i t i s found thatthe cardiac impulse is more forcible than normal.On percuss ion i t is found that the area ofnormal

cardiac dulness is much increased. From the factthat there i s an increased area ofapex heat, fromthe fact that i t is carried considerably to the left,and that the cardiac impulse is more forcible thann ormal, and that there is increased area of dulnessn the precord ial region to the left

,we are led to

h e conclus ion that there is hypertrophy of the l eftheart.

On auscultation , a blowing sound i s heard , synchronous with the first sound , has its greatest i htensi ty at the apex

,is conveyed to the left

,and i s

heard beh ind.

A slight murmur i s also heard at the base, andis conveyed into the carotids. There i s somequestion

,however, as to whether the latter murmur

is conveyed from the apex or belongs to a lesionat the aortic valves. I t seems to possess a different character from the murmur heard at the apex ;and from the add i tional fact that it i s heard in thecarotids

,I shou ld be incl ined to regard i t as a

murmur indicating organ ic lesion at the aorticorifice. We have

,then

,in this case, aortic ob

struction and mitral regurgi tation. There is alsohypertrophy ofthe left heart, with some d ilatationof its cavity. There may also be some d ilatation ofthe right ventricle

,indicated by th e oedema ofthe

feet but before d eciding th is poin t I should wishto examine the patient’s urine.The tr eatmen t ofth is case is for the most part

purely hygienic. He should take iron daily. Whenthere is failure ofheart-power, as is evidenced bythe oedema ofthe feet, d igital is may be ofservice.The better treatment in that particular, however,is to preven t fa i lure ofheart-power by avoidingevery tli i ng which calls the h eart into active service.Life in the country is better for h im than life in thecity. He should

,if possible

,l ive in a cl imat

where there is the least l iabil ity ofhaving anotherattack ofrheumatism . For, after one attack ofrheumat ic endocarditis, every subsequent attackrenders the case worse and worse

,until finally the

heart gets into an unmanageable cond i tion andgoes over to complete fai lure ofthe right, whenthere will be no hope of afford ing permanent , perhaps not even temporary rel ief— M ed. R ecord.

George W. Meyer, aged fifty-three, appl ied to me1n January

,1 87 7 , for rel ief ofa n euralgia ofthe fifth

nerve ofeighteen months ’ duration . The diseasebegan w ith a sl ight prick ing sensation in the roof ofth e mouth

,left s ide. In a short time this was suc

ceed ed by the most intense pain , wh ich followedthe d istribution ofthe superior maxillary nerve , andafter the lapse ofseveral months occas ionally affected the inferior dental branch .

From the well—known character ofthe physicianswho had been previously in attendance I had l ittleto hope for in the way of medication , feeling fullyassured

.

that they had used every remedy l ikely tobe ofservice to h im .

I at once proposed to exsect the nerve, but theproposition was decl ined

,and I set to work to de

Vi se measures ofrel ief.The patien t had become emaci ated from the ef

THE CANADA LANCET.

n igh at the

but with no success counter-irri tation only aggravated the trouble croton choral hydrate gavesligh t bu t transien t rel ief.For days and weeks and months th is man walked

the floor of his room,the victim of a pain constantly

present,bu t wh ich

,in frequent paroxysms ofin

tens ity, compelled h im to assume all th e shapesand figures ofa professional con tortion ist. Noth ingbut a narcotism dangerous to l ife itse l f gave himany immunity from suffering

,and th is was succeed

ed generally by an aggravation ofthe pain .

At last he consented to an operation,and on

February 2 7 th I performed a mod ification ofCar

tu rnedantrumThe

leash of nerve formed by the div is ion ofthe superior maxil lary after l eaving the infra-orbital foramen was now dissected from the under-surface ofthe flap

,and a treph ine five-eigh ts ofan inch in

diameter appl ied to the bone,with i ts crown over

lying the infra-orbi tal foramen,and its po int on a

l ine perpendicular to the same. Afew turns of theinstrument soon removed the button ofbone

,and

the cavity ofth e antrum was brought into view. Areflecting mirror fastened upon my forehead lighted

well,and no d iffi cul ty was experienced

breaking down the floor of the orbitthree-cornered ch isel provided for thatthe nerve along the infra-orbital canalstopping to suppress th e hemorrhage

he antrum,which I perforated

inch trephine,thus exposing

Here the hemorrhage frominternal maxillary artery whichspheno-maxillary fossa gave riseby patien tly wai ting and apply

ABSTR ACT OF A CLINIC BY PR OF. FLINT,

BELLEVUE HOSPITAL,NEW YORK

ENDOC ARDITIS .

ing smal l pieces ofsponge tied to whalebone th ebleeding was controlled

,and the operation com

pleted by breaking down and removing Meckel’s

gangl ion and dividing th e orbital,spheno-palati ne

and posterior dental branches , and by means ofa.pair ofsmal l curved scissors dividing th e nerve ‘

at

i ts point ofexit from the cranium through the foramen rotundum .

The hemorrhage having ceased,the parts were

well cleansed and the flap brough t down to its positiou and secured by seven s i lver wire su tures.The Operation occupied about an hour.

The patient rallied well,union by first intention

occurring except at th e poin t where a ligature wh ichhad been applied to th e infra-orbi tal artery passedout from under the flap . The sutures were removedon th e sixth day

,and the l igature came away on

the seventh .

The operation,sofar as th e rel ief ofth e neu

ralgia depending upon the superior maxil lary nerve,was a complete success . The pat ient’s generalheal th stil l continues to improve, but he occasionally complains ofpain along the l ine ofth e lowerjaw and in the lower teeth . Should this continueI intend to exsect a portion ofthe inferio r dentalbranch — D r .Fow ler

,K i ngs C o.

,N . Y.

,M ed . S o

ciety’

s p roceedings .

Before introducing the next patient I w ish to

make afew general remarks on the inflammatoryaffect ions of the heart. Card i t is i s a subj ect ofl i tt leimportance

,and need n ot detain us ; but endocar

d i ti s is deserving of the closest attention on accoun tofthe very serious resul ts wh ich are so apt to fol lowi t. I t i s a remarkable fact that th is affection wasut terly unknown unt i l very recent t imes, and thati ts d iscoverer

,the d istingu ished Bou i l laud, is stil l

l iv ing . Perhaps,however

,i t is not so strange, after

all,that i t escaped not ice so long, s ince we never get.

acute symptoms w i th i t except when i t occurs i nthe rareform of u lcerat ive endocard itis. We are

perfectly fam i l iar w i th i t now,i n conn ect ion w i th

rheumat ism and Brigh t’s d isease,and yet even i n

acute rheumatism ,when i t sets in

,there is no ap

preciable difference i n the symptoms. We have todepend ent i rel y on physical exam inat ion for i ts detect ion

,and th is art

,as you are aware

,has not been

known long. The pat ient whom I now bring beforeyou entered the hospital wh i le suffering from acutetubal nephri t is

,but had no heart-trouble whatever.

Afterwards i t was noticed that he had , and the murmur heard was a m i tral systol ic on e, loud, rough ,andfor the most part confined to the praecord ium .

It was never regurgitan t (not being transm i tted be

THE CANADA LANCET.

yond the apex) . Now we have a bas isfor diagnos1s.The h istory of the case is as fol lows. James G . ,

40 years of age , and a nat ive ofEngland,was ad

m i tted to the hosp i tal about a fortn ight ago. He isa garden er by occupat ion

,and h is fam i ly h istory i s

good . He acknowledges that he is a hard drinker( tak ing more or less l iquor before breakfast), but d en ies that he has ever had venereal d isease . Hish eal th was good U p to the commencem ent ofh isp esen t attack . Three weeks before that t ime hecaugh t cold

,and drank an un usual quan t i ty of spir

i ts . Somewhat later he not iced some oedema ofthefeet, and th i s ex tended unt i l h i s whole body becamewater-logged. At the

'

sam e t ime he suffered fromheadache, nausea, and vom i ting but he n everthelesscont inued work ing as wel l as drink ing. The n ightbefore h is adm ission he had a v iolent attack ofdel i r ium ,

three m en being requ ired to hold h im i n

bed . He says thatfor six mon th s past he has beenpassing a larger quanti ty ofu rine than n ormal , andthat there has been n o change in th is respect oflate.

On adm ission,i t wasfound that he was suffering

from gen eral oedema,but the chest sound s were nor

mal . The urine was markedly album inous, andcon tained both large and small hyal ine casts. U n

d er the influen ce of act ive cathars is,and cupping

over the reg ion ofthe k idneys , the oedema rap idlyd isappeared. There was at on ce a marked improvem en t in his cond i t ion

,and the del irium from wh ich

h e was suffering when adm i tted gradual ly subsided.

He was afterwards put on d igital is.On e week ago he complained ofsome pain in the

chest,an d on exam inat ion there was d iscovered a

soft blow ing murm ur at both the apex and base ofthe heart . I t was loud an d rough

,extend ing over

the ent ire card iac area. We have here the ev idenceofan acute endocard i t is . In l isten ing to the murmur you w i l l not ice the difference in the soundover th e apex and over the body. Th is has n o spe

c ial sign ificance,and is simply due to the d ifferent

condi t ion s in the differen t parts . The patient isdoing wel l ; but i t i s st il l a question in h is casewhether the acute affection d id not supervene upona chron ic on e. I f the albumen does n ot soon d i sappear

,we shal l conclude ei ther th is, or that the

present is on e ofthose rare cases in wh ich chronicBrigh t’s d isease succeeds to acute nephrit is.

PER IC ARDITIS .

Wh i le speak ing upon these inflammatory cardiacaffect ions, I should l ike to have an acute ease ofpericard i t is to show you ,

bu t , un fortunately, thereare none in the house j ust now . Under these circum stances I shal l have to do the best I can and

the pat ient whom I now present to you i s on e who

had an attack ofth is affect ion a month ago. Hish istory is as fol lows. W il liam B . , a native ofG erm any

,25 years ofage, and a seaman by occupat ion .

He was heal thy up to three years ago, when he had

a severe attack ofrheumat ism,last ing about a m e

He had no pain over the praecordial region att ime. (Per icard i tis , as you are aware

,,is morefro

quently associated w i th rheumat ism than w i thother d isease

,but i t i s al som et w i th in Bright’s d is

ease,as wel l as in pleurisy and pneumon ia) . His

present i l lness commenced one week before he wasadm i tted to the h osp i tal . Th is—was anothe r attackof acute art icular rheumat ism

,and i t fi rst affected

the ankles,then the knees

,and afterwards the

hands and fingers. Just before adm iss ion he noticeda pain over the praecordial region . It was at firstdull

,bu t afterwards very acute

,and accompan ied by

dyspnoea.It i s noted in the h istory prepared by the house

physician that the pain and swel l ing in the l imbswere greatly rel ieved by the r ide from h is res idenceto the hospi tal in the ambulance

,so that he was

able to walk about the ward on h is arr ival here.

Th is serves to show the benefi t ofwhat I may cal lm e thod ic frict ion . When a joint is affected w i thacute rheumat ism ,

great rel ief can be given by rubbing i t w i th some l ubricat ing l in imen t

,at first w i th

the l igh tes t poss ible touch,and afterwards i ncreas

ing the pressure appl ied until a very considerableamoun t offorce can be used

,to the great com fort of

the patient . The ride in the ambulance,n o doubt ,

had some such effect as th is . At present the patien tsuffers from no dyspnoea

,and the pain has almos t

ent irely d isappeared . On auscul tat ion a loud , harshfrict ion-sound was heard all over the praecordial region , and also a soft blow ing murmur at the apex ,but n ot transm i t ted beyond . I t may be laid downas a rule that when w e have rheumat ic pericard i t isthere is also endocard i t is presen t. The treatmen tcon sisted at first oftwen ty grains ofsal icyl ic ac idevery three hours

,together w i th counter- i rri tat ion

over the heart. Afterwards the iod ide ofpotass iumwas given . After the patien t had been in th e housea few days the presence of flu id in the per icard ialsac was detected, as wel l as in both pleural cav i t ies.O ne week ago the n ote in the h istory is that themurmur st i l l con t inues

,but that th e flu id is gradual

ly d im in ish ing, wh i le the pat ien t’s cond i t ion isgreatly improved. Personally

,I have n ot exam in

ed the pat ient as yet, and before doing so let m e

run over the phys ical signs of pe ricard i tis. Thefrict ion-murmur wh ich is on e ofthese characteristicsigns i s always l im ited to the praecord ium , or extends but very sl ightly beyond i t . We are not toldin the h istory that there was a large effus ion in thepericard ium in th is case. Let us suppose that therewas. W e should then have found a total absenceofheart impulse. On auscul tation , the heart-soundswould have seemed al l m uffled and d istan t , andboth the first and second sounds would have beenvery much al ike. In such cases the firs t sound isalways n otably weak and valvular in character.Another indication ofthe affect ion is the area ofdulness extend ing j ust over the area of the peri car

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THE CANADA LANCET.

Dr. F . found the heart palpi tating.

’

He satisfiedh imself that i t could not be enlarged, that therewas no valvular les ion

,and informed the pat ien t

accord ingly,

’

assuring him that there was no danger, and that he should make h is mind easy. Hewas instructed

,however

,to come again for another

exam ination . wh ich he accord ingly did the dayfollowing. At this exam ination the heart wasbeating rapid ly, the impulse d id not give th e impress ion offeeblenes , and there was a systol icmurmur heard over the body ofth e heart

,bu t not

transm itted beyond the apex. The opinion oftheprevious day was repeated

,and after receiving

some general directions the patien t left. Dr. F.

had an urgent summons in the even ing to whichhe could not respond

,and Dr. Peri y vis i ted the

pat ien t. Dr . F remarked that there was on e circums tance in the patien t’s h istory which did nothowever make the impression upon h im wh ich i tshould

,and that was a period ofunconsciousness

after runn ing upstairs . Dr. Perry obtained thish istory : The patient during the afternoon wasseiz ed with another fi t ofuncon sciousness , whichlastedfor afew moments

,during wh ich time there

was marked l ividity. Dr. Perry, on h i s arrival,

found the pulse no t deficient in force,and beating

with regulari ty . He recogn i z ed the murmur, butnoth ing else ; gave a favorable prognosis , prescribedan etherial stimulant and left. During the samenigh t Dr. P. was again summoned to find to hissurprise h is patien t moribund

,unconscious

,and

with scarcely any appreciable pulse . Of coursein a short t ime th e patien t died . Dr. Fl in t

,in the

absence ofany better causefor death , assumedthat fatty degenerat ion existed , and yet during l ife ,notwi thstand ing careful examinations

,no auscul

tatory ev idence ofsuch a condition was found .

The case was ofinterest n ot only in i tself, but asproving that there is no danger, and yet even atthe risk ofa mistake such an assurance should n otbe d en ied to them . In answer to quest ions frommembers

,i t was further stated that there was no

membranous effus ions in the meshes ofth ecolumnae ; that a few week s before death the patient suffered from shortness ofbreath .

Dr. Janeway remarked that fatty degenerationof the heart was blamed for more sudden deathsthan i t deserved . Especially was this the case indeath s from chloroform

,the sl ightes t amount of

extra fat upon the surface ofthe organ being seiz edas the immed iate cause of death .

Dr. M . P . Jacob i referred in th is connectionto a specimen ofheart presented last spring, inwhich the cause was not explained by any distinct pathological reason ; and Dr. Janeway calledattent ion to specimens ofheart containing a ir,l ikewi se exhib ited by him at a previous meeting.

CANCER or THE STOMAC H W ITH ABS ENC E or PAIN .

Dr. E. C . Seguin presented a stomach removed

when shetenn ial, bushowing aher years . After her return she suffered fromdyspepsia

,anorexia

,and nausea . Dr. S . saw her

Nov. 1 sth , The only symptom she then com~

plained ofwas great weakness and marked emaciat ion . Dr. Thurman discovered a painless swell ingin the left hypochondrium , j ust below the borderofth e ribs . From the absence ofall posit ivesymptoms this tumor al so d iscovered by Dr.Segu in , was though t by both gentlemen to beimpacted faeces . The swell ing was manipulatedand enemata given , and after a few days the massseemed to disappear after the discharge of severalscybalous masses. In the beginning of Decemberi the symptoms of dyspepsia became more marked.

The first vom i t ing occurred only two weeks beforedeath

,was very

‘

slight in character. Abou t th ist ime there was regurgitation offood , mixed wi th al i ttle brownish liqu id . At no t ime was there anycoffee ground vomiting. The emaciation pro

gressed , the repugnance to food was very great,and the loss ofstrength was extreme. Shortlyafter the d isappearance ofthe tumor in the lefthypochondrium , there was another tumour nearthe median l ine and on a level with the othertumor, which was d uly recogn iz ed as an independent affair and as a cancerous growth. Thespecimen was chiefly interesting in connection withits cl inical h istory. The specimen on examinationwas mainly composed of cyl indrical epithelium .

Dr. Briddon referred to a case of cancer ofthestomach , in which there was no pain or vomit ing,but in which the diagnos is was made from theprogressive emaciation. He asked if absence frompain was uncommon .

Dr. Fl in t answered that the absence ofmarkedpain was the rule.Dr. M . P . Jacobi remarked that

,before arriving

at a d iagnosis ofsuch cases by exclus ion, two

d iseased cond it ions should be taken into acoun t,

v i z . : the prodromic stage of leukaem ia, and progressive pern ic ious anaem i a .

Dr. Janeway mentioned a case ofcancer of th estomach

,the diagnos is ofwhich he made by d is

covering the umbi l icated nodules of cancer of thel iver. As primary cancer of the l iver is rare

,and

as secondary d isease follows cancer of the stomach ,th e presumption is legitimate that the latter cond i tion ofth ings exists . In addition to th is evi~dence when a tumor of the stomach exists, thed iagn osis is qu i te positive.In regard to vom i ting as a symptom, much

m igh t be said. He bel ieved that i t Was “

mostfrequen tly associated with deposits in the neighborhood ofthe pylorus . In that situat i on the

'

I‘

HE CANADA LANCET.

in those,absence ofvomiting and pain was

rule — Med . R ecord .

ITISH ASSOCIATIONFO R THE AD

VANCEMENT OF SCIENCE .

annual meeting ofthe Briti sh AssociationAdvancement ofScience, was held in PlyThe Presiden t, Allen Thompson ,

guished member ofthe medical professioning address. His subject

ofthe Forms ofAnimal

organisms are very numerous. I t i s now provedbeyond doubt that the origin ofputrefaction andfermen tation is dependent on th e presence in thesubstances which are the seat ofchange in theseprocesses , or in the surrounding air

, ofthe germsofminute organisms ofan an imal or vegetablenature, and that the main tenance of the chemical

esses mainly cons ist i sly ( if not essential ly)and multipl ication of

Prof. Lister had the merit of being the fi rs tto apply the germ theory ofputrefaction to explainthe formation ofputrid matters in the l iving body

,

and he has founded on th is theory the now wel lknown antiseptic treatment ofwounds

,th e impor

tance ofwhich it would be difficul t to over-estimate. The success or failure of plans for the preservation ofmeat and other articles offood with

are themd theiron thems

,and

tence ofh . Theguideformsman

,

thembi lity ,

8 1

G R AVES’

S DISEASE, (EXOPHTHALMIA)»

CLINIC .

BY WM . PEPPER,M .D .,

PH ILADELPHIA.

We give th is name to a group ofsymptoms , ofwhich enlargement ofth e thyroid gland, protrusionofthe eyeballs and disturbance of the heart’s actionare th e ch ief. I t i s not merely the thyroid enlargement wh ich const itu tes the d isease

,for you know

that in many parts of the world goi tre,even of

extrem e degree,i s very common

,and yet such;

cases are not to be regarded as in any way iden tical wi th G raves

’

s disease . I t wil l be found , ins imple goitre

,that the enlargemen t is progressive ,

and consists ofa s imple hypertrophy ofth e gland ,unattended with either pulsation or thril l , andthat there is an absence of exophthalmos and ofcardiac d isturbance. Moreover

,the causes which

lead to simple goitre are often endem ic,as in the

val ley of Switz erland , although the affection also~occurs in a sporadic form but in such cases thepecul iar influences which favor the developmentofG raves ’s disease are wanting. We can better ‘

appreciate these and other points upon a study ofthe present casesMrs. J . L.

, 56 , married , born in Germany. Hashad twelve children

,the youngest ofthem being at

present I 4 years old . Most of her labors havebeen diffi cul t

,part icularly th e last. She was much .

affected by the loss ofher husband a few years .ago

,who d ied from the effect ofgunshot wound ‘

received during the war. She has suffered fromfrequent leucorrhea

,pain in her back

,an d other ’

evidences of u terine d i sease. She has had rheumatism occasionally. Her menopause occurred twoyears ago , when she was fifty-four. Since that timeshe has noticed palpitation

,choking sensations , .

blurred vision,and exophthalmos . She is ofa very

nervous temperament,and very easily frightened .

She is diz zy every now and then . Blowing,.anaemic murmur in pulmonary artery. Pulse 1 40

No valvular murmur. Thyroid gland enlarged.

with pulsat ion and sl ight thril l.Wm . S .

, aet. 1 7 , born in Buck’s County, Penn

There is very great probabil ty,indeed , that all the

zymotic diseases (by which we understand th evariousfom i s offevers) have a sim ilar origin. Ashas been well remarked by Baxter in an able .

paper on The Action ofDisinfectants, ’ the analogies of action ofcontagia are s imilar to those ofseptic organisms

,not to processes s imply ofoxida

tion or deoxidation . These organisms, studied insu itable fluids

,multiply indefini tely when intro

duced in al l but infinitesimal proportions. Thusthey are

,as near as we can perceive

,the very“

essence ofcontagia.” - l e Doctor .

82

sylvania. Had a severe attack of typhoid pneumonia at about the age offourteen . S ix monthslater he narrowly escaped drowning, and rece iveda severe nervous shock . Last summer h e had amild sunstroke. After his escape from drowning hebecame very nervous and eas ily agi tated. In sixm onths

,palpitation ofthe heart appeared

,and

then marked enlargemen t of the thyroid gland .

He has suffered frequently from sudden attacks ofth e thyro id

,with thri ll and pulsation . Heart’s

action much disturbed,but no valvular murmur

slight exophthalmos .The causes which produce th is disease are ex

c ess i ve care,anxiety

,overwork, particularly if com

b ined with deficien t or improper food. In somec ases, i t would certainly seem that the disease wasinduced by pregnancy or confinemen t, and in not afew cases

,in females

,th e predispos ing cause seems

t o be severe u terine d isease or menstrual disorders .I have spoken ofthe three symp ton s, but a glanceat the cases w il l show that these Sympton s are present in d ifferent degrees in d ifferent cases. Forinstance, the enlargement ofthe thyro id gland maybe moderate or even sl ight ; or, on the other hand,i t may be truly enormous. In these latter casest here may be occas ional sensations ofstrangling orofgreat diffi cul ty in swallowing

,from the pressure

ofthe enlarged gland upon the trachea or oesophagus . I t usually happens that the enlargementvaries from t ime to t ime. As a rule

,both lobes

a re equally affected,though one may be somewhat

larger than the other. The thyroid gland is h ighlyvascular, an d the arteries l eading to it are verytortuous . When

,then

,there is violen t arterial

o ver-action we wou ld be prepared to find pulsat ionand thril l over the gland. These phenomena are

frequently present in G raves’s disease ; in some

c ases they are present at times only,wh il e in other

c ases they may be absen t throughout . The chara cters ofthe thyroid enlargement point stronglyt o the view that

,i t is due to a di lated and enlarged

c ondi tion ofthe vessels with some hypertrophy ofthe glandular and fibrous tissue

,and possibly w i th

a , varying degree of interstitial serous effusion . Inconnection with th is we must note that there isfrequently violent throbbing ofthe caro tids andofthe ir branches.The exophthalmos is no l ess varying in i ts in

t ensity in some cases i t is so sl ight as to attractbut l ittle attention wh i le in others i t is so extremethat the globes cannot be covered by the l ids,and i t becomes necessary to protect them from inj ury by exposure to ai r and dust . The protrusionseems to be due to the d istention of the vessels ofthe post-ocular tissues

,wi th serious infi ltration ,

and perhaps some hypertrophy of the cellulo fattytissues beh ind the globe .

The d isturbance ofthe heart is the most constant, and is frequently the earl ies t of the sym ptoms. It also varies much in degree . There is

THE CANADA LANGET.

heartl iable to paroxysms ofirregulart imes from very sl ight. causes.anaemia which usually coex ists

,i t

find marked anaem1c murmurs atheart, along the cours e of theand over the j ugular ve ins in the neck .

The diagnos is of G raves ’s d isease can presentbut l i ttle d iffi cul ty if attention be paid to the characteristic features above ind icated. I t i s really avery curable affect ion in many instances,prov idedit come under treatment at .an early stage , and thehygienic condit ions can be rendered favourable.Even when cure cannot be effected , the troublesome symptom s can be held in check. In advanc

ed cases,or when the cause persists, the symptoms

grow more grave. Anaemia becomes i ntense,dilatation of the heart, with degeneration ofi tsmuscular fibre ensues

,circulation fa ils, dropsy

supervenes, and death follows from exhaustion andgeneral anasarca.

In the treatment the greatest careto the removal of the causes , and ingood food

,change of scene, and

from cares,The various functions

fully attended to,and local disorder in females re

moved by suitable treatment .

ent ind ications,and w ill

,therefore , be cal led for in

different proportions in d ifferent cases. D igital isis th e most valuable remedy for controll ing thefunct ional disturbance ofthe heart. I tgiven freely (gtt. x. to xv.

, three or fourday) , and continued for long periods atIron is absolutely essential when anaem iais frequently the case , and whenmarked large doses of iron shouldin whatever form is most acceptable to the system.

arterioles,but we have obtained most excellent re

potass ium is frequently called for, partlycount ofthe general nervous cond it ion , butto assist the d igital is or ergot in controll ingregular action ofthe heart and arteries.

THE CANADA LANCET.

TETANUS.

that I l ectured on lastced tetan ic seizure . Heofhis severe symptomsin a semi-s tupid condi

i n question try to discover whether th e complaintbe self-l imited or not. Tetanus has no t a definitecourse to run , and it should therefore, be possibleto control or shorten i t. H ow does tetanus kill apatien t ? There are generally two ways in whichd eath occurs either from stoppage of respiration ,caused by general tetanic spasm , stiffening andcontracting th e diaphragm and res trict ing the chestwalls

, or more u sual ly, from the profound exhaustionbrough t on . The contracted muscl es ofthe j awsand throat interfere , too , with al imentation , andhasten the fatal resul t. To come down to thebottom facts

,then

,in th e general ity ofinstances

the inabil ity to take food leaves the enormousconvulsive wear and tear ofthe muscles unpro

vided against The all—important treatment ofte tanus

,therefore

,resolves i tsel f into careful and

prompt nourishment ofth e patien t . The feedingm ust be systematic, and must be carried on atshort intervals

,every two or three hours during

day and nigh t, unless the patien t i s able to sleep ,‘ in which case the interval may be lengthened tofour hours during the night. In severe casessol id food must be avoided ; the mere effort to

then you canserious would be the immethe convulsion surprise thebolus offood in the throat.rely on l iqu id food . Milk isine diet. Beef tea and beefexcellent temporary s timulus,them possess much stayingto milk

,raw or pulped meat,

aked crackers and bread , etc. ,I th ink very highly ofpulpede ofgood

,j u icy beef, ou t of

a bread board and scrape itife. In th is way all th e pulp

ofthe meat is extracted and the indiges tible fibreleft beh ind. The resul ts ofth e scraping may begiven in th e form ofcroquets, or mixed wi thbrandy and sugar

,Be su re

,too, that you don

’tt el l your pat ien t that you are giving him rawmeat otherwise you may have diffi cul ty in gettinghim to take it . Then

,absolute quiet is n eces

sary, Every paroxysm is a period of intensework , and so rest is pecul iarly demanded . NObody must be allowed to come into the room ,

and the nurse must wear carpet slippers,and do

no talking. The room,too

,had better be dark

ened. As regards medical treatment,alcohol

must be given in nutrit ive doses,not as a stimu

lan t therefore , give i t in smal l quantit ies withthe food , in milk , or in the shape ofraw eggsbeaten up with wine . Among drugs there isscarcely any remedy which has not been used , andI have no doubt that some physicians th ink theyare all about alike in value ; I am satisfied , however, that proper treatment i s productive ofgood.

Some patien ts, indeed , wil l get well and somewill die, treat them as you may . There i s

,how

ever, a res iduum ofcases which proper treatmentat the proper time will save . In choosing ourremed ies, then, what do we want ? Evidentlysometh ing that wil l l essen the motor action ofth esp inal cord , al lay undue sen sibil i t y , and forcesleep. I use , in their due place , six drugs chloroform

,ether, opium ,

n itrite ofamyl,the bromides,

and cannabis indica. The homoeopath s have re

commended strychn ia,but

,as migh t be expected,

i t only increases the spasms . Some have usedbelladonna, but I th ink that as a stimulan t ofth espinal cord i t does harm . In protracted cases , ofcourse, the remedies have to be changedfrom timeto time. Three ofthose I have mentioned arebrief, and rapid in their

’

action v i z . : chloroform ,

ether and n itrite ofamyl. Their effects pass ofvery quickly. As the spinal cord is continuallyirri tated in tetanus

, you would have to admin istern itrite of amyl every five or ten minutes to getany lasting effect. The verdict i s

,of course,

agains t any such improper use ofthe drug. I tsonly proper use is to get a temporary effect invery severe cases . Therefore don ’t employ i t asthe main treatment

,but only as an auxil iary. So,

too , with chloroform and ether. Chloral and thebromides are the best known depresso-motors . I tis often very useful to comb ine several remediesin your treatment ofthe disease you must, however; not give them all at the same time . I wouldadvise something l ike the following plan : Bringth e patient well under th e influence of the bromideofpotass ium

,by an in i tial dose ofhalf an ounce,

followed by half a drachm every three or fou rhours . Then, to obtain sleep at nigh t, administer,at bedtime , thirty grains ofchloral with someopium . Nitrite ofamyl should be employed fromtime to t ime

,to stop violent spasms . If bromism

THE C ANADA LANCET.

comes on , you may substitute cannab is indica forthe bromides be sure

,however

,that you employ

a trustworthy preparat ion ofthat drug. A greatdeal has been said and written concern ing the socalled traumatic treatment in this d isease

,in the

shape of blisters appl ied along the spine . Th isseems to me like adding a new peripheral irritat i on to one already existing there. A bl ister onthe nape ofth e neck is ofgreat value in reducingcerebral congestion . But I am real ly afraid oftheher01c treatment. Some, too , have highly advisedthe con t1nued application ofice to the whole lengthof the spine. I doubt whether even the steadyuse ofwe will affect the spinal cord . I have madesome experiments myself

,to tes t the penetrab i l ity

of cold applications to the external surface ofth ebody. The application of ice to the head ofacat, for example, will affect perceptibly the base ofthe brain , but the mass ofbone and muscle whichcovers the spinal cord precludes

,as I should th ink

,

the poss ib il ity ofany profound impress ion ofcoldthere . With respect to nerve stretch ing

,which

has also been tried,I am not a believer. If

,i h

do

eedc

a nerve be constricted in a mass ofcicatric1al t1ssue, i t would be perfectly righ t to cu t downupon the cons tricted part and free i t ; in othercases I should be in fear ofa severe neuri tis bei ng se t up by the op eratioThe man who is before you has had no spasm

for a week, and is now entirely rational, with butslight mental hebetude

,and very little delirium

dur i ng sleep. I attribute this result mainly to thebl i ster, medical treatment, and systematic feed ingat short intervals. His mind has been alwaysclearer after a bl ister to the neck has begun todrawn— M ed . S urg . R epor ter .

1

TUMOUR OF THE LOWER JAW R EMOVEDWITHOUT EXTER NAL WOUND .

Ellen M . ,aged 33 , was admitted into Mr.

Maunder ’s Ward,at the London Hospital

, on

j une 4. About December last, the pat ien t firstnoticed a smal l swell ing ofthe gum

,near the

back teeth,on the right side ofth e lower jaw .

On admission,the right cheek ofth

bu ldged outwardly, and, on lookingmouth , a reddish growth , th e siz e ofwalnut, occupying the site ofthe molwas visible. I t was painless

,hard and

much resembl ing gum-tissue.On June 8

,the patien t bein

encein a da gag A knife with a rounded end

,guide

the tip of the left forefinger,was made t

vide th e soft parts over the anterior margin 0

ramus j ust about its j unction with the base 0bone, and then the periosteum and musattachments on both s ides were separated wraspatory. Thewith a small saw

,

d isplacedthe body of the bone was cut perpendth is spot by means of the saw and th

After the kn ife had been passed alongof the fragment to d ivide the mucousand other structures down to th e bone,tory andforefingers then completed theThus the tumour an

was unimportant,no artery requ iring l igature .

R emarka — Mr. Maunder said such washistory ofa case offibrous epul is . I t was benignbut recurred unless the bone surface whence igrew was al so removed. Further

,the growth wa.‘

generally pedunculated,but in th is ins tance i t wa.

sess i le. Seven years ago (March 9 , 1 8 70) hthad

,he said

,demonstrated in that theatre 1111

feasibil i ty ofremoving , w i thou t external woundlarge lateral port1ons of the lower j aw

,the seat 01

the tumour. The patient on that occasion was

ten years ofage , referred to h im by Mr. Owen , 01Leatli erhead . From that ch ild he had taken awayan extent ofbone comprised between the middleof the left ramus and the s i te ofthe right can inetooth . The second case similarly treated was sentup by Dr. Dove

,ofP inn er i Both patients have

s ince been often seen in cap i tal heal th , and he feltShe thought i t was merely a gumbo i l ; i t was justified in stating “ that the practice of our art

ne1ther tender nor painful , and i ts colour was ofwil l have one horrora reddish tin t. When the tumour had beengrowing for about two months

,the patient sough t

advice of her “ doctor,who strangulated i t w ith

catgut, and a p iece ofthe growth came away .

Th is operation was performed a second time,and

another p iece removed. After th is two decayedteeth were extracted . The skin oppos i te the seatofthe tumour

'hacl been painted three t imes dailywith tincture of iod ine

,wh ich seemed to retard

the growth . The mass was always hard,and the

patient could even masticate portions ofher foodon th is side . Occas ionally it bled a little . I

be assured that nohis face .

” He needofthe female shouldfrom d isfigurement .point ou t the d istino

THE CANADA LANCET.

ts were gettingfor the original

,

ofoperation — Lancet,June 23 , 1 8 7 7 .

69° L ibrary .

E or THE TR EPH i NE IN DEPRES S EDOFTHE SKULL-(T/ze B r ink/z M’

ea’z’

cal

IIud son,

op in iont,and toobtainedquestionthat the

districts aroundin the considerayears the operaacture of th e skulloccurrence, and,large percentageensue

,there are

enerally obvious causes to account for i t, such as

“2 . In compound fractures ofth e cranium

,i t

th e effi cacy ofesitated to em

e hem iotomy among5 but the statisti csrivate practice showeration for the reduepractically harmless

,

open the peri tonealt ionate tohas been

to the operat ion . (Holmes’s

iv. page Althoughevery respect a completephine at the earl ies t posat preventing misch ief byirritation .

85

6 . No matter how d eeply prejud iced againstthe treph ine our young surgeons may be whenfresh from th e schools

,afew years ’ experience

generally dispel s the illu sion ; th ey become con

verts to th e practice ofthe district,and cease to

look on i ts employmen t as antiquated surgery.

”

In G uy’

s H osp i tal R epor ts for 1 8 7 7 , Mr. Dav iesCol ley contributes two interesting cases in wh ichthe trephine was successfully employed

,and adds

,

“ These two cases support th e rule wh ich mostof our text-books ei ther miss orfai l to impress

,

that in punctured fracture ofthe skul l i t is th e surgeon ’s d uty to trephine at once

,without waiting

for symptoms ofcompression or irri tation .—M ed .

METHOD or ARRESTING H EMORRHAGE AFTERExc i sron OFTHE ToNsrLs .

— In removing the tonsils with the guillotine , i t is imp ortant to rememberthat the organs are si tuated obliquely, l ike the pillars ofthe soft palate ; more pressure should bemade upon the lower than on the upper border ofth e instrument

,and the tonsil w il l then be read ily

seiz ed . It i s better not to attempt to remove thewhol e ofth e organ , for after the removal ofa port ion the rest will atrophy, and removal ofth ewhole is l iable to be followed by dangerous andvery obstinate hemorrhage . The hemorrhage maybe due to the existence ofinflammation at the t imeof operating

,which inflammation also has a ten

deney to make the substance ofth e organ friabl e,so that i t will have to be removed in small p ieceshence it is always advisable to defer the operationuntil th e inflammatory stage has passed .

The great danger ofhemorrhage, however, l iesin the poss ibi li ty of opening into the rich venousplexus

,which l ies at the bottom ofthe tonsillar

fossa,and which is very easily wounded when th e

tonsi l is removed entire. The hemorrhage fromth is so urce is sometimes extremely profuse, and iskept up by the movements of deglutition and spitt ing. The bleeding is not always primary, hencei t is necessary to keep the pat i ents under observat ion for a t ime. Sometimes i t recurs after i t hasbeen once arrested . All the usual methods ofchecking the bleeding are unrel iable, wi th the exception ofdirect compression made by the fingerof the surgeon. The finger should be introducedin to the mouth and applied directly to th e wound

,

wh ile counter-pressure is made from in front. Thisposit ion must be main tained for several minu tes

,

notwithstanding th e attacks of su ffocation , the

efforts at vomiting, and the cough which the method exci tes. The hemorrhage is generally arres tedat th e end of two minutes . Dr. Panas, ofth eH6pital Laribo is iére i n P aris

,has on three occa

sions been call ed on to stop considerable hemorrhages from this cau se, and succeeded in promptlyarresting them by this procedure — M ed ical R ecord,August

,1 8 7 7 .

86

VASO—MOTOR MECHANISM .

Dr. Bowditch , in h is report on the R ecent Progress ofPhysiology (B oston M aud S . saysthat Huiz inga has concluded that the vaso-motorapparatus consists of

Local gangl ia pres iding over the rhythmicalcontraction ofthe vessels.

2 . Vaso-constrictor fibres (spinal) going directlyto the arteries.

3 . Spinal nerve fibres inh ibiting the local gangl ia.

4. Inh ibitory fibres from the skin to the neighbour ing gangl ia.

A local irri tation ofth e skin may cause eithervascular d i latation through 4 , or vascular con stricthrough 2 . Which resul t i s produced dependsupon the local i ty, and the in tensity of the irritat ion .

Masins and Valna’

ir regard the spinal vaso-constr ictor fibres ( 2) as acting through the local gangl iainstead ofd irectly on th e vessel s, and they adm i tthe existence of exciting as wel l as inh ibitoryfibres , runn ing from the skin to the neighbouringgangha.

All recen t investigators assume the existence ofnerve cells in or near the vascular wall s, to accountfor the recovery of their condition oftonic contract ion after sect ion ofthe sp inal nerves, buthistologists have only rarely succeeded in bringingevidence in support ofth is assumption .

As,however

,we find in the walls ofthe small

intestines a pl exus ofnerve cells and fibres whichseem to preside over the movements ofthat organ ,i t i s no t improbable that the blood-vessels may besubj ected to s imilar control .O stroumoffhas shown that th i s peripheric vaso

n i otor apparatus, whatever may be its structure, isable to hold the blood-vessels in a state ofton iccontraction after division ofthe spinal nerves.The theory that the spinal nerves contain two

anatomically d istinct sort ofnerve fibres has beenadopted by nearly all recent investigators to explain the fact that stimulation ofthese nerves mayb e' followed e ither by vascular constriction or d ilatation : O nimus has

,however

,been led to the

conclus ion that inh ibitory phenomena resul tingfrom the stimulation ofa nerve

,do n ot necessarily

prove the ex istence ofspecial inhib itory fibres inthat nerve . He found

,in the first place , that a

s ingle moderate irritation ofthe vagus , instead ofarrest ing the heart, prod uced a contraction of thatorgan ; also that when in a curarised an imal theheart-beats have been reduced to forty or fifty perm inute

,i t was poss ible

,by irri tating the vagus , or

the heart i tself,with induction shock s at the rate

ofsixty per m inute, to compel the heart to con

tract synchronously with the electrical stimulation .

O n imus therefore concludes that when electricalirritat ions are ap pl ied to a nerve at a rate approach

THE CANADA LANGET.

appl icable .

THE DIR ECT METHOD OF AR TIFICIAL.

R ESPIR ATION .

Dr. Benjamin Howard, ofNew York, read apaper on this subj ect (B r i t. M ed . Association ) , inwhich

,having pointed out what he bel ieved to be

the defects of other plans , d escrib

constrictor fibres .Th is theory affords no explanation

that while tetan ic stimulation ofa fresh lycauses vascular constriction

,the same st

appl ied to a nerve several days after ithas the opposite effect. Moreover

,the

tor fibres seem in many cases to run inanatomically distinct from those of th estrictor fibres . For instance

,the

paratus has assumed,in the absence of

coming from the central nervous system ,

degree ofactivity than it formerly possessed.

Stricker has,however

,shown that th i s is not the

only method by wh ich such a result may be reached.He concludes from h is experiments : First, thateach vascular region is suppl ied by many vasoconstrictor nerves

,which leave the cord at d ifferent

places ; secondly, that after division of the cordbetween the lumbar and dorsal regions

,th e res tora

tion of vascular ton ici ty in the hind limbs is effectedby the vaso-constrictors

,wh ich leave the dorsal

cord above the point ofdivision . He considers i tprobable that thes e vaso-constri ctors have the i rcentres in the sp inal cord (or in the brain) , andthat they are not ofthemselves too weak to ma intain the ton ic i ty ofth e vessels which they supp ly,but that after division ofth e cord , they graduallyacquire greater power. Stricker proposes the termcollateral innervation

,to express this process

Ti te Doctor ) .

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8 8 THE CANADA LANCET .

D I S EAS ES IN WH IC H GALVAN ISM Is US EFUL.

Lead paralysi s wil l not yield tofarad ization after ac ertain period has elapsed , though the con tinuouscurrent (from a many-cel led batte ry) w il l stimulatem uscles to contraction when th e interrupted (farad ie) current fail s ; and after the use ofthe continu ous curren t for a time the faradic current may beu sed succe s sfully. In th is disease , and in infantileparalysis , success may be expected if the treatmenti s begun early. NO t ime must be lost .R heumatic and hysterical paralysis are often

5 ;eed ily cui ed by faradism , but cases Of the latterkind will s

-nn e times disappoint the physician byt

'

i e l iab il ity to recurrence ofthe symptoms ; ofc ourse moral and m ed ical treatment w ill be added .

Constipation,when dependent on deficient nerv

ous power and paralysis ofth e bladder, sometimesy ields to the farad ic current.Amenorrhoea has been most successfully treated

by many phys icians by electricity ofgreat tension,

o btained either from a fractional machine (GoldingBird) or from a faradic apparatus . I t is stated that

just as the interrupted current stimulates the menstrual functions, so the continuous current wil lcheck menorrhagia. (There is difference of opinion on th is point.) Ergot of

,

rye is so sure andS peedy an excitor of u terine contraction that elect rici ty has no t been tried by many men . In a caseofaccidental hemorrhage In my own practice somee rgot had been given , but the contracti on of theu terus not appearing strong , I used faradism withthe effect ofthe immediate expulsion ofa foetus.and placenta, and shortly after ofa very large clot.With a small pocket apparatus

,such as G aiffé’s,

and two electrodes,one flat (carried with wash

l eather)for the abdomen , and the other shapedl ike a rectum-bougie for the uterus, i t would bemost easy to accelerate a tedious labor if ergot hadfailed

, or if there were any reason for withholdingIt.Several spasmodic diseases have been treated by

electric ity with excellent results,and especially in

the case of writer’s cramp, which requires the useofa cont inuous current appl ied to the musclesaffected. Which muscles are affected the operatormust first d iscern by carefully observing the l imbwh ile the patient makes effort to write . Observat ions made by Dr. Poore and others Show thei ncrease ofpower in muscles while a galvanic current is be ing passed through them . Shaking palsyi s said to be improved by R adcl iffe ’s pos itivec harge, if used in the earl iest stages.

Electrici ty should be tried in a sphyxia, as it hasb een rel ieved so many times by the employmentOfa faradic current passed through the scalen i andthe diaphragm . The upper electrode should bes mall (a brass ball covered w ith mo istened washl eather is best) and if it is branched wi th two term inals

,the current can be appl ied to both S ides

ofthe neck at once, a moistened sponge connected

the epigastrium .

Anaesthesia of hysterical origin has lately beenrel ieved by Prof. Charcot , by placing plates ofmetal over the parts affected. Cases ofthis kindmay be benefi ted by faradization . But it is scarcelynecessary to add that local treatment alone is notl ikely to be of permanent use.The results ofgalvanization ofthe seat ofpain

in neuralgia have been very encouraging. Ten totwenty cells ofa Daniell or Leclanché battery areemployed , and the Sponges are appl ied so as toinclude the painfu l spots between them . Theappl ication Should be made dai ly — D r . C aseyC oomos , in M edical P ress and C i rcular .

DIAG NoS IS OFH IR D ISEAS ES IN CH ILDREN .— In

exam ining a ch ild suspected to have h ip -d isease,be

careful to place h im on something firm and flat ;a tab l e covered with a blanket

,a leather couch

,or

the floor. If you use a soft bed, he wil l sink intoit,and you will perhaps overlook even a consider

able deformity. Do not be content with anythingshort of a thorough examination. Do not pretendto say whether a child whom you have examinedwith h is trowsers on has or has not hip-disease.Let him be undressed , so that you can move h isl imbs w ithou t being hindered by h is clothes.Girls past early childhood may be fully examined

,

if you use a shawl or a loose sheet to cover them .

I . You must look for abnormal posture ofthel imb or ofthe pelvis ; 2. For stiffness ofthe j oint3 . Observe whether the glutei or the muscles ofthe thigh are wasted

,or whether any

,especially the

adductors , are rigid ; 4 . Or whether there is anyswel ling about the j oint or in the thigh or the il iacfossa 5. Notice the relation ofthe trochanter tothe side ofthe pelvis as compared with that ofthe opposite side ; 6 . Look to the length ofth el imb as compared with that ofi ts fellow ; 7 . Seehow th e patient walks, if he is able to do so 8.

I f he have pain,learn its s ituation and its c harac

ter.— H oward M ars/z,i n B r i tt

'

s/zM ed ical y oar nal.

R EMEDYFOR BROM INE AC NE — TaoD octor saysthat a patient in St. Bartholomew’s Hospital , whohas bromine acne as a result of taking half-drachmdoses of bromide ofammonium to stop her ep ileptic fits

,has been rel ieved of the acne by the use of

the following lot ion

R —Sulphuris precip. ,

Spir. camphorae,Aquae calcis,F iat lotio .

The meet ing ofth e Internat ional Medical Congress was held in Geneva

,commencing September

oth. The Pres ident was Professor Vogt ; th eVice-Presidents

, C r itchett (England) , Esmarch

(Germany) , Schnitz ler, (Austria) , Hardy (France) ,Worlomon t (Belgium) , Palasciano (Italy) , andSims (America) .

THE CANADA

TOR ONTO,NOV. 1

,1 8 7 7 .

THE CONTAGIUM VIVU M THEOR Y.

11 view ofth e recent ve ry elaborate argument ofW. R oberts, F. R . S .

,Manchester

,del ivered at

British Medical Association Meeting,last Aug

ust, any utterance to the contrary will be regarded

as of interest. We have followed Dr. R oberts

through h is admirable argument and we fully sym

path ise with the views advanced, based as they are

upon recent actual pathological discoverie s . Wenotice

hhowever, a letter in the number ofthe LAN

C ET ofSeptember 2 2nd,in wh ich an utterance of

Dr. Burdon Sanderson is quoted to the following

effect, “ that i t can scarcely be supposed that th e

agent is a l iving organism,

” which is the active principle in septic l iqu ids— and th is substance, we mayadd ,

'has been termed by Dr. Sanderson py r ogen ,

their le tter before referred to,claim to

observations upon experiments with 1 70

originally published in the tenth annual

th e Sanitary Commissioner with the gov

f India in which i t is stated that

we have nophenomena

in troduction

solutions ofalvine discharges

,and ofother

substances,are not the resul t

aterial, th e poisonous proper

endent on its possessing vital

d Lewis fu rther state

t so eminent an expon

LANCET. 89“

ent ofdoctrines regarding th e causation of disease,

as is Dr. Burdon Sanderson,has now arrived at

similar conclus ions, and that he has, on the present

occasion submitted viewsfor the guidance ofthepublic health offi cers at home

,so much in accord

ance with those previou sly arrived at,by the sister

department in India; they quite agree that it would

have been betterfor pathological science if suchconclus ions had not been so much overlooked

,for

th efacts on which they are based are quite irreconci lable with the often too carelessly received as

sumption that the process ofseptic in fection is dependent on the development ofa l iving contagium .

”

That Dr. Burdon Sanderson has come to regard

the septic poison,called by him py rogen as other

than a l iving organism,i s quite true but we fear

the gentlemen writing in the LANC ET assume toomuch when they say that Dr. Burdon S anderr

son’s views have undergone any change necessaryto bring them into harmony with their own . I t is

always very flattering to'assum e to have been the

first to poin t out a new fact in science , but the fact .

of Dr. Sanderson having given the septic poison

i ts specific name py rogen ,i s a suffi cien t evidence of

h is recognition ofit s true character, Messrs . Cunn ingham and Lewis to the contrary n otwi thstand

~

ing .

The theory of minute organisms and th e sp e

c ific origin ofdisease in the last few years, has donemuch to give exactness to medical though t in the

direction ofcausation and pathology ofa largenumber ofdiseases h itherto bu t imperfectly understood. I t would be impracticable to follow Dr.

R oberts through the whole ofhis argument, hencewe can only refer our readers to thi s most masterlyelucidation ofthe modern theory ofcontagious diseases . Bacteria are minute organisms which , al

though small in siz e and simple in form , are pos

sessed ofwonderful vital endowments. Dr. R ob

erts associates the yeast plant and its allies , and al l.

the numerous species and varieties of bacteria un

der the general designation ofsap rophy tes— a term

intended to include under on e head al l the organ

i sms associated with the d ecomposit ion and decayoforganic matter. He proceeds to show that bac

teria,l ike other organisms

,arise from pre-existing

parent germs,and are the actual agen ts in all de

composit ion and putrefaction . By his experiments

he substantiates the proposIt i on that organ ic mat~

ter has no inherent power ofgenerating bacteri a

90

an d no inherent‘ power of passing in to decomposi

t ion also that bacteriaare the actual agents ofdec omposition , and proves , that the i r source is alwaysfrom unfi l tered air or water

,which

,if true

,suggests

e i ther somemode ofprotectin g wounds from con

t act with unfi l tered air,or th e appl ication of some

agent capable ofdestroying these germs as theycome in contact with a wound. The latter i s the

p rinciple a dopted in Prof, Lister’s ant i-septic method. In considering sep ticaemia , Dr. R oberts alludes to the poison resul tin g from the decomposi

t ion ofanimal substances known as py rogerz,wh ich,when absorbed

,produces fever. The patient has

c ome under the influence ofthe septic po ison ,wh ichi t i s the obj ect ofth e anti-sep ti c treatment to defendh im against. Now he says

,although py rogen ,

o r sep t1c poison is t he resu l t ofdecomposition ofanimal substances

,yet i t is fully establ ished that de

c omposit ion cannot take place without bacteria,and

that bacteria are never produced spontaneously,but

o riginate invariably from germs derived from thes urrounding media.

Passing on to‘

relapsing fever, he tell s .us that in1 8 7 2 , Dr. Oberme ier, ofBerl in , discovered m inu te

.spiral organ isms (spirilla) in the blood of patientsS uffering from relapsing fever

,wh ich discovery .has

s ince been fully verified by subsequent observat ion s ,and most strange “ these organisms are found during the paroxysms, disappear a t th e crisi s, and areabsent during the apyrexial period. This h e cons iders proof positive ofthe exi stencd ofa sp e cia1d isease germ

,as a disturbing cau se in fever. He

next referred to splenicfever, concerning which heobserved that th e fi rst trustworthy observation ofthe presence oforganic forms in the infecti ve dis

eases, was made in splenic fever. In 1 855 , Pollen~der discovered minute staff-shaped bacteria in th isd isease

,which are short

,straight and mot i onless

T his discovery has been confi rmed by Brauell and

Davaine,Boll inger

,Klebs

,Tiegel

,and lastly by

Koch . The.

oacci llas antlzraci s present in splen icfever has been found by Koch to be preserved an dreproduced by Spores

,and may exist for any length

oftime in a very persistent manner in dwellings andother places where the disease has been .

This method of research by which cause and effeet are so directly traced to each other

, .opens upa new era in practical medicine

,and sends us off

in a new direction in the wake of the pathologist,

who mus t ever lead the van in true medical pro

THE CANADA LANCET.

l ike rational ideas about the nature,“or igin

Spread ofzymotic diseases~,

— a kind of,knowl

most valuable tothel

s

’

ani tarian aswell as thes ician .

THEI AR YNGOG R APH.

A, method bfinvestigation at once so ac

and rel iable as the graph ic has provedstudy

to be

connebody

,

deed,in point Of m inuteness and

the graph ic method has been to the registrat ithe an imalfunctions, what; the polariscope hasin the analysis ofthe secret ions, represent ingn i tely and d irectly the normal as wel l as the mor abnormalfunct ions Of the human body.

The pract ical resul ts ofthegraph i n the exam ination ofdetect ion of various d iseasedheart affect ion s, has led to disct ical and theoretical interest anby charts produced any Sk i l led observer could reaé

at a glance the nature ofthe affecti on , the stage 0deve lopment

s im i lar l inedevelopment ofa means ofapplying the graphi cplan to the observat ion ofaffect ions of the throa1

and l ungs, result ing in the production of the Laryngograph , i ntended to ind icate the influence ofthroad iseases; upon the. qual i ty ofthe voice. The appa

tratus was first introduced as “ Koen ig’ s Flami

i Manometer, but was afterwards mod ified so as ttbe capable of responding to the sl ightest variatiOI

i n sound,mak ing i t appl icable to the study ‘

ofabnormal condi t ions ofthe human voice. Howfar i ‘may be able to serve the profession , i n the ear l)d iagnos is of affect ions of the'throat and lungs, re

mains to be discovered.

It i s composed of a gas-jet, burning w ith a smalflame

,a mouthp iece term inating in a lent icular boa

or capsule, an d a large cube, whose vert ical sideare covered w i th m irrors, and wh ich i s revolvablt

about i ts vert ical ax is. The capsule i

THE CANADA LANCET. 91

the sound

mot ion ofd ist inctly

of the vocal chords In the case. of

fierence in the appearance . oftheso stri king, that a sk i l led observerect idea ofthe actual state of. theW h i le the pat ien t speaks or s ingsou th -p ipe, the physician ,

standing

the changes produ ced inm irror. I n a m oderate

errations are but imper~regular and constan t in

The tongues ofl ight are less clearly

rter, in con sequence ofthe range ofthe vocal ch u ,

u s much smal ler

degree of hoarsenes s ,formation oftubercles in the lungs

,

ch ron ic inflammation,w ith th icken ing

in “ the clear, regular and

tee th ofl ight in the case of

BR ITISH VACCINATION ‘ ACT.

We have been favoured by Sir Sidney Waterlow,

M .P., for Maidstone, with a copy ofth e amended

Vaccination Act, 34th and 3sth V ictoria ofth e

Imper ial Parl i ament,many ofth e provisions of

which , would form the basis for an amended Act

in the.Dom in ion ofC an sda. I t must long have

been paten t to every member of our profession

that the existing Act is inoperative and almost

useless, and with th e large representation ofmedical men in the House , we have a righ t to expect

that from some ofthem ,a Bil l on th is subj ect

should b e introduced at the next session . The

divi sion ofevery Townsh ip in to school sectionswil l greatly facil itate enquiries in to the number ofunvaccinated

,i f proper medical offi cers are ap

pointed for that purpose. The supply oflymphshould

,as in England

,be under the supervision of

a G overnment . Board , so as to insure immunityfrom impurities. I t is a matter for wonder, that in

th e present day,when so much more attention is

paid to th e prevention ofdisease than formerly,that vaccination shou ld be so much neglected,more particularly in th is Domin ion

,drawing an

nually from all parts ofEurope, a large amount ofpoor settlers

,exposed in the . transi t to the chances

ofinfection . Although vaccination is sometimes

powerless to protect us from variola,i t always

dimin ishes the gravity ofthe malady. This pro

perty which J enner. and h is firs t followers did not

even suspect,is thoroughly proved by the various

fluctuat ion in the intens i ty facts wh ich have been accumulated. I n one ofnctly vi s ible.

”

appears i n the Septemberthe most terrible epidemics ofvariola that hastaken place in Eur ope since the discovery ofvacc ination— that of Marseilles in 1 828, more than ten

thousand persons were attacked ; ofthese,two

t housand only,had been vaccinated , and of that

number,only for ty-five died whereas, on e thou

sand fi ve hundred ofthe eigh t thousand who hadInot been vaccinated, were carried offby the pes ti

n ish the cue so st il l greater ach ievements in thed iagnosis of throat and lung affect ions especial ly.

The. add i t ion al development ofth is arrangement,

so as to attach to i t a sensi t ive paper on wh ich toimpr int a permanen t photograph of the flame p ic

ture,would add immeasurably to i ts general ut il ity

,

and there cannot be a doubt but that ingenui ty w i llaccompl ish th i s improvement.

92 THE C ANADA LANC ET.

lence . (See M . Serres report Academy ofSciences. )Vaccine matter evidently loses part ofi ts effi cacyin passing from arm to arm

,i t is therefore desirable

to renew i t as often as possible. Comparatively

recent discoveries have proved that we can renewit at wil l by vaccinating he ifers

,the lymph thus

obtained being more powerful,and less open to

objection than from the long transmitted Jennerianvirus.

The propriety ofre-vaccination is now fullyestablished. In Germany the various govern

ments have paid great attention to the subject,

owing the circumstances ofepidemics ofvariolahav ing manifested themselves with a severity towh ich we had become quite unaccustomed sincethe introduction ofvaccinat ion . R e-vaccination

has been consequently resorted to on an extendedscale, having the effect of arresting the epidem ics .Thus in Wurtemberg,forty ‘ two thousand persons

who had been re-vaccinated,only presented e ight

cases ofvarioloid whereas,one-third of th e cases

ofvariola have occurred in persons vaccinatedonly in i nfancy. I t is principally between the agesof fourteen and thi rty-five that vaccinated personsare mos t l iabl e to be attack ed by variola. When

there is an epidemic,th e danger commences

earl ier, and children ofnine or ten years ofagemay be seiz ed. Prudence

,therefore

,requires that

under ordinary circumstances,re-vaccinat ion should

be performed at the age offourteen or fifteen,and

even earl ier, if wi thin the radius of an ep idemic.

PHOS PHO-NU TR ITINE AND M ILK or MAGNE S IA.

-Anong the many addi t ions that have recentlybeen made to the l is t ofnew remed ies

,there are

few that merit more fully the approbation oftheprofess ion than that of Pfiosp/zo a new

and important preparation of th e Soluble WheatPhosphates, and the M ilk ofMagnes ia .

The importance ofthe first named wil l ' readily

be noted by the fol lowing extracts from well knownauthorities .Of the S oluble W/zeaz‘ Phosphates Prof. Grace

Calvert says “ The phosphates contained in

wheat are soluble ; they are not combined with

organ ic matter,but are in a free condition ; fur

ther, the greates t part are those of potash and

magnesia.

Prop. 1. V. Lieb i g remarks The sign ificance and appliances.

gist i t is known that,the other const ituents oaffording nourishment.”Phospho-Nutri tine will

ordinary medicines calleinasmuch as these are

and soda— the least of importance inthe daily waste of our organs — while intion

,the phosphates of Potash and M

greatly predom inate,and the superiority

th is d ifference gives, must , be apparent totelligen t mind and instantly recogniz ed

Facul ty.Of the M i lk ofMagnes ia Prof. Gisborne

I t has a smooth and milk-l ike taste, is th

of al l antacids,and whether used for child

adults,physicians wil l find

,

that this hydrat

sesses all the medicinal pro3. much h igher degree thanbonated preparations ofthaPhys icians wish ing to try e i ther ofth

die s,may obtain a supply from Devins

Montreal .

NOVEL EXPER IMENT.— Dr. Fuller, ofMont

has conce ived the novel idea oftrephin ingportions of the skul l of an idiotic child

'

ofyears old , to allow the expansion ofthe brain ,thereby afford the faculties

developing,wh ich had not b

case. S ince the operationmarked improvement in theand a paralysis ofth e arm

,wit

of extremities has been quite remed ied.

faculties ofin tell igence have brightened ups iderably ; and, encouraged thereby, i t isFuller’ s intention to take out another piecskul l

,and note the result

NEW In sTR U MENr .— We were lately

very ingen ious combination ofSim’s an

Speculum,manufactured by Mr. Gross,

treal,which is admirably adapted to the n

of Operators . Every hospi tal , at least, 5

possessed ofon e,

conven ient in the 0Gross hasafford ing

THE CANADA LANCET. 93

AMBULANC ES IN CONNEC TION WITH HOS PITALS .

— Some years ago th e Board OfCommissioners ofChari ties and Correction for New York

,establ ish

ed a reception hospital in the City Hall Park,

known as the Park Hospi tal,where urgen t ca

of diseas e or acciden t could be received and at

amongst us does not know the earnestness Of tended to until they could be removed up town to

: appeal, where delica te health , narrow means ,claims of society

,the displeasure ofa husband,

urged most tearfully in support of an undesired

:em ity by those whom we would be disposed to

fiend ? What young man amongst u s who has

been obl iged to rej ect a proffered bribe whereimpecuniosi ty seemed to give hope to the wouldfoeticide What practitioner

,who has not found

adv ice “ not to kil l ” spurned by one who lookedrimfor help in ri dding her ofthe frui t she wasring ? Some years ago he was present at an

resting meeting ofphysicians at Malone, N . Y.,

the aged president dwel t,among other things

,

this topic. He told us Of a married lady,one

t is best patients, who wished to be relieved, at

early period ofgestation , Of the legitimate fru itwas bearing. He expostulated, coaxed , and

although he had

years previously,

im. But to con

own satisfaction,

fine afternoon,a young lady ofeigh teen

full ofl ife,and heal th , and beauty, m igh t

seen pass ing my window, l i t tle dreaming how: h she was indebted to the humble Old man in

Offi ce near byfor the continuance Of the l ifenow so much

;U Be TU TEFO R CHLOROFORM .— Dr. R i chard

er at the British Association on the

medicine

ming pos

eh excellent resul ts m ay be expected.

the Bellevue Hospital . In connect ion with th is

temporary hospital , a conveyance or ambulanceforcarrying the s ick was employed this was the commencemen t ofthe ambulance sys tem in New York

.

Bellevue Hospital has now s ix ambulances ready

to s tart at a momen t’s notice to any part Of the

city, and is also connected by wires with all the

pol ice and fire-alarm stations in the city. TheNew York hospital has two very handsome ambu

lances in connection with that Institution,and

lately the R oosevel t has also provided itself with

an ambulance. A surgeon is sen t out from the

hospital with each ambulance to look after the

patient and perform any duty that may be n ecessary. The new ambulance Of the New York

hospital cost $800 ; those Of th e Bellevue, $600each , and the one recently purchased for theR oosevel t, cost only $3 50 , and is quite equal toany ofthe others .

LONDON HOS PITAL MEDIC AL COLLEGE — A mostsuccessful convers az ione” was held at the Open in gof the w inter session of the London Hospi tal Medi.cal Col lege

,Eng. I t was largely attended. A

numbe r of Canad ian students are now attendin gth is school.

B I CARBONATE OFSODA IN BURNS .-Dr. Waters

,

of Salem , states that bicarbonate ofsoda, or any

other alkal i,in neu tral form

,will afford ins tantane

ous rel ief from pain in th e severest burns or scalds,

and will cure such inj uries in a few hours. At a

late meeting Ofth e Massachusetts Dental Society,

he performed the following experiment. Dipping

a sponge into boil ing water,the Doctor squeez ed

i t over h is righ t wrist, producing a severe scald

around h is arm two inches in width . Bicarbonate

Ofsoda was at once dusted Over the surface,a wet

cloth appl ied,and the pa in , th e experimenter

s tated,was almost instantly rel ieved. Although

the wound was Of a nature to be open and painful

for a considerabl e time,on the day fol lowing th e

single application of the soda, the less inj ured portion was practically healed, only a sligh t discoloration of th e flesh being perceptibl e.

94 THE C ANADA LANC ET.

ADVERTI S ING OPERATIONS .— We are constantly

receiving notices cl ipped from newspapers in different parts of the country, containing accounts ofOperations performed by med ical men . We dot suppose that any Ofthese gentlemen are’ gui l ty

Of describing their Own operations yet we are at

a loss to know how it i s that many surgeons, bothin cities and in the country , who stand deservedlyhigh

,in public and professional estimation,

are never not iced by the members ofth e fourthestate

,al though they sometimes perform doz ens of

Operations in the course Of a twelvemonth ? The

code of medical ethics by which the regular pro '

fess ion is governed in this country, and also in theUnited States

,is very explici t on this point : The

clause referring to this matter, we quote asfol:lows

“ I t is derogatory to th e dignity Of the p rofession to resort to public advertisements

,or

i

private

cards,or handb il l s inviting th e attention of indi

v iduals affected with particular diseases, publ icly

offering advice and med icine to the poor gratis,or

promising radical cures ; or to publish cases andoperations in the daily prints, or safi r sac/z

i

p ablz?

catz’

omfa be made ; to invite laymen to be present THEORY OFCONTAG ION .— Ifcontagion

at operations, to boast of cures and remedies, to C laim ed by Tyndal l, Ofdefin i te part icles,adduce certificates Ofskill and success

,or to per float ing in 83 8 , 01‘ in the air, 01‘ i ll the

form any similar acts . These are the ordinary drink ; and that l ikepractices Of emp irics, and are highly reprehensiblein a regular physic ian .

”

AC TION OFSUNL IGHT ON VIRUS .— We have

somewhere seen a statement cred i ting a distingui shed English physician with having made some

interesting experiments on the “ power of sunsh ine

to destroy poison. Having Obtained some poi son. the nox ious elements that surroundfrom the C obra on ivory points , from London , he Address

, C an . Med . Ass’n .

exposed them in a glass bottle to the sunligh t ;some of the poi nts were protected by a paperwrapping, while a number were fully exposed. Onthe latter, or those having the benefit Of the fullsunl ight this most deadly poison i s said to havesoon become harm l ess, while those protected by

the wrapping retained their poison in all i ts fatalactivity. This resul t agrees with the general ex

,

per ience and Observati on of those making use ofvaccine virus on ivory points to any great extent,a very short exposure to the sunligh t be ing sufli

cient to destroy their efficacy by neutral iz ing thevaccm e.

Dartmouth College,

Medical Class, on on

ing that “ th e sciencenow a growth

,and

reached perfection .

”

c ine is that man wasold age, but ofvarioofl ife. R ecov

several conditiocal man who i smay be sent for

be followed, and his prescrip tions may

gently dispensed, or altogether d ispensed

cannot keep watch and ward by every b

prevent nurses from d osing their victim

grave. And , more than a ll, howevermay know oftheorya great many th ings Of which he . i s ign orant

,

which,

can only be learned by. l ife-long observa

and experience, and wh ich may be termed thewritten language of medicine. His anxietie s

necessarily at times be great.

APPO INTMENTS .— Dr. Burland has been a;

pointed House Surgeon to ‘ the Montreal Genera

Hospital,and Dr. Bell assistant ‘ Surgeon; DI

Matthews Duncan,of Edinburgh

,has received a]

appointment at St. Bartholomew’s ‘Hospital,L0!

don— the post vacated by Dr. G reenhalgh . DI

McLeod, of Glasgow,

has been appointed S urgeo:

to the Queen in Scotland,

H . P. Yeomans,M .D .

,of

Associate Coroner for theT. S. Walton

,M .D .

, OfPaSociate Coroner for the D istrict OfParry sound.

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“96 THE CANADA LANG ET.

careful examination Of the symptoms , the presence«ofstone was also suspected , and a very smalls ound (the largest that could be introduced owingt o th e stricture) was passed with difficul ty. The:susp icion was confirmed a smal l stone was

found to be present. The patient was at once

put under preparatory treatmen t. The urethra

was gradually dilated until a NO . 14 catheter could

be readily introduced . This required a good deal

Oftime and patience, besides the spl itting Of one Ofthe strictures near the anterior part Ofthe urethra.As soon as the lithotrite could be introduced, the

Operation was performed. The calcu lus was found

to be about 1% inches in diameter, very soft

and friable,and readily gave way. The bladder

was subsequenty well washed ou t, and the case

is progressing favourably.

£ 00115 and Qamphteta.

=C YC LOPIEDIA OFTHE PRAC TI C E OFMEDIC INE , Vol.XVI . , on D i seases ofthe Locomotive Apparatusand General Anomal ies of Nutrition by Prof.Von

'

Ziemssen . New York : Wm . Wood Co .

We are in receipt of another volume ofthis excellen t work, which should grace the shelves ofevery practit ioner anxious to keep pace with theadvanced medical l iterature Of the age. Thisv olume l ike some that have preceded it, has been

w ritten by several au thors : Prof. H . Senator, of

B erl in, discusses“ R heumatic effusions Of the

w joints and muscles ; Prof. E . Seitz , of Geissen ,“ Disorders caused by catching cold ; Prof.Immermann , Of Basil , “ General disorders ofnutriJtion ,

” and Prof. Birch H irschfield , OfDresden ,“ Scrofu losis and affections ofthe lymphaticglands .” Each writer exhausts every minutiae of

h is subj ect,and presents the reader, in addition to

a j udicious compilation,a valuable record Ofhis

own experience. I f we selected portions Of thesevarious theses

,we should be doing inj ustice to the

work as a whole,by unravell ing the thread by

;wh ich the comp iled materials are held together.We cannot do better therefore, than strongly re

commend the work as the most exhaustive tran sla

t ion in to the English language on the various subjects on

'

wh ich it treats . The work wil l be extended to two volumes more than was at firstContemplated

,making in all seventeen. The fol

AMYL—N ITR ITE IN WHOOP ING COUGH .- I

min ims repeated every 2, 3 , or 4

to the age Of the child and the urgency ofsymptoms. NO antagonism exists between tremedy and quinine.

The annual death-rate OfEdinburgh is aboutper thousand.

On the 25 th September, in Toronto, Mrs.McC ollum ,

of a son .

On the 1 6 th ult., the wife ofDr. Temple,Toronto

,of a daughter.

At Stratford,on the ro th ult., J . R . H

Esq ,M .D .

,to Sarah Leonora, eldest d

Mr. A. B. O rr.

lowing five volumes are yet to appear,Vol. X

on “ Neurosis,

” in Dec. ’

7 7 . Vol. XII I .,Diseases of the spinal cord

,in March

,

Vol. XVI I; on “ Blood diseases,

” in June,

Vol . VI I I . , on“ Diseases Ofthe abdominal

cera,” in Sept. ’

78 , and Vol . IX.,on

“ Skineases

,in Dec. ’

7 8 .

PHYS IC IAN ’S VI S ITING LI ST,by H . C . Wood,M

Philadelph ia : I. A. Lippincott 8: C O .

This List presents many features wh ich are pel iar to its elf

,and which will be found very C

y en ien t. In add i ti on to the ordinary space

the name, there is also one for the address ofpatient. I t contains an erasable tablet

,l ist

medicines and doses,diagrams Ofmotor points

musclesforapplying electricity,blanks for ac

rendered," nurses ’ addresses

,Obstetric

,engage

&c. &c.

THE PHYS IC IAN ’S VI S ITING LI STFOR 1 87 8.

delphia : Lindsay Blakiston.

The above mentioned Visiting List haspubl ished regularly for the las t twenty-sevenI t is now Offered to the profession in a mostform

,such S l ight improvements having

made every year as experience seemed to su

We give the work our warmest commendation.

THE CANADA'

LANCET.

HE ANADA ANCET,A MONTHLY JOURNAL OF

MEDICAL AND SUR GICAL SCIENCE .

abrigiual dummuuiratinua.

INTUSSUSCEPTION OF THE ILEUM .

BY w. A. WILLOUGHBY,M.D., C OLBORN

’E, ONT.

I was called on Wednesday, Oct. 3 rst, at 1 1a.m .

,to see Mr. S .

, ag ed 63 , who had been seiz ed

suddenly with pain an hOur before whil e in thefield assisting h is men in digging a ditch . He had

been engaged in the same work for some days

previously withou t suffering any inconvenienceand none was fel t up to 1 0 a m . th e time of the

attack. He was as wel l as usual in the morning

eating his breakfas t hearti ly and having had a free

evacuation from his bowels. I found him in extreme torture

,complaining ofcons tant and con

tinuous pain in the lower part Of the abdomen .

localiz ed if at any spot"

in particular,a l i ttle to the

right Ofthe median l ine,about half way between

the umbil icus and th e pubes , not enough to th e

right side,however

,to make one suspect trouble

at the ileo-caecal -orifice— though when asked to

point out the seat of pain he would pass h is hand

Over the whole pubic region. Accompanying the

pain were’

violent'

attacks of vom iting’

occurring

every few minutes, the ej e cted matter being mucus

and bile. Superficial examination ofthe '

abdomeri,

the walls of which were quite lax,revealed noth ing

sugges tive,'

and nothing was discovered by digital

hernia.”

The heart’s action

the'

pulse being 80,and in

beat in every 8 or’

I O .

on Hoffman ’s anodyne,

in

in ims'

ofchloroform being

anti ty was repeated

first hour. I also

water,to which was

This emptied thee patien t was

i

grow

97

ing worse,pain becoming more severe

,notwi th

s tanding, I had used hypodermically grain of

morphine. He lay on h is back keeping h is body

perfectly motionless,and h is suffering was very

acute . As I feared the case would prove to be

one Of invaginated bowel,I gave a C Op ious injec

t ion Ofwarm water (3 quarts), in wh ich was dis~solved 25 grs . ofextract of be l ladonna. I passed

th is up slowly and had i t retained for fi fteen m in

u tes,when I allowed i t to

.come away, which i t did

without carrying any faecal matter with i t. 1 gave

by th e mouth, 1 5 grs . of calomel and grain of

morphine,believing it would have th e bes t chance

Of remain ing on th e stomach . I left a similar

powder,to which was added

,5 grs . ofjalap in e, tobe given in two hours after previous one, and

directed that he should have free inj ect ions of

warm water every two hours: I left at’ one O ’clock

and did not see him again until seven , when I

found that the instruct ions had been followed with

out any benefi t as far as the bowel s'

were concerned— though the pain was lulled somewhat. I re

mained five hours with h im— at t imes patiently

kneading the bowel s,again giving inj ection s

,to

some Ofwhich I added extract ofbel ladonna ,placing him on his right i side with h is shoulderslow down and his hips elevated as much as

poss ible,

-withou t any change in h is condition .

I left him at mi dnight with orders that nothing was

to be given till s ix in the morning when I saw him .

He had used the bed-pan twice withou t havinganything pass his bowels, though the urine hadpassedfreely.Upon manipulation ofth e abdomen now,

a dis

tinct enlargement could be fel t in the right i nguinal

region,apparently about the ileo~caecal orifice

,a

couple of inches from th is,and directly to th e left

or i t,another enlargemen t could , with diffi cul ty, be

made out. This last was very painful— the former

not at al l painful on pressure. I gave an inj ection

every two hours— the bowels to be rubbed gentlywith the hand at interval s during the day.

The pulse was now about 1 00. The vom i t i ng

was pers istent,but not stercoraceous no faecal

Odor from the breath . I saw h im in the evening ,when

‘

I had the pleasure Ofmeeting Dr. McDonald ,

ofBrighton,’ and Dr. Gould, of Colborne . The

enlargementfi rst mentioned, i n the inguinal regionhad entirely disappeared, but h is C ondition had

.

grown rapidly H is pulse“

was.

almost im

98

perceptibl e at the wrist. The extrem i ties were

cold in spite of every appl ied means to restore

warmth. We considered h is case hopeless— infact he was in a state of collapse at the time— andnoth ing to what had been resorted to in the case

could be added. There was a faecal Odor fromthe las t ej ecta from the stomach. We gave himhalf a grain of morph ine and ordered brandy everyhalf hour, which he could not keep down, as Ilearned in the morning. From his condition at

th is time, we did not think it poss ible for h im tolast another twelve hours.

I saw him in the morning,Friday

,Drs. Thor

burn, Powers, and Go uld, seeing him with me

during the day. His condition was very much

changed since last night. He was now perfectly

easy, not having any pain even on manipulation .

Extremities .warm stomach quiet ; heart’s action

easy and natural ; pulse 90 and perfectly regular,i ts intermittency having ceased w i th the cessationofpain. As he was in such a comfortable condition , we decided to let h im alone for the day

,

which we did, and see him next morning (Satur

day).This morning, as the bowels were much dis

tended and tympanitic, we decided to give him amuch larger inj ection than he had as yet. Two

gallons were slowly passed up, the anus being

aided in retaining i t by a napkin firmly pressed

against i t. With this quantity offluid in thebowel

,we raised him in to a perpendicular position

,

heels up. While gen tly rubbing the bowels before

letting Offthe inj ection,we had the satisfaction of

seeing h im make a star t as if someth inghad givenway. Pressure being removed from the anus thefluid came away as if driven by aforce pump.

With the las t Of it there were . a couple offaecalcasts and a quantity of dark grumous matter. There

was a distinctly gangrenous odor from the expelled

contents. We repeated the inj ection in two hours;This l ikewise carried away a quantity of the same

well pronounced gangrenous matter. we l efthim and returned at nigh t to find him sinking. Hehad had a couple of motions, principally grumousmatter and blood s ince morning. He passed a

quiet night and l ived till two O ’clock on Sundayafte rnoon. . H e is the fourth Of the samefamily

THE C ANADA LANCET.

ileum found indications

from the ileo-caecal orifice. This part of the small

intestine was empty, as also the large intest ine

above the diseased portion the small bowel wasfi lled with fluidfaeces. R emoved the impl icatedportion, which we afterward found to be by measurement 1 8 inches. On the outside Of thecarcerated part and for some four inches abovetwo below

,the whole surface was intensely

gorged with blood. The sheath over the

vaginated part was j ust five inches long on the

caecal s ide of inj ury the re was a ruptured bandofabout one-half inch in width. This was evidently

what had given way during the inj ection ; on the

upper s ide there was a firm band one inch in width.

This band was very firm and d irectly above

commencement ofthe sheath.

Sl itting the bowel up from the lower extrem it

the upper limit ofthe sheath wefound a loop of bowe lcompletely encased. This loop of in testine measured nine inches. The mucous coat ofthe bowe lwas engorged til l i t seemed a mass Of blood . There

were a number Of gangrenous patches,one of wh i ch

was much more advanced than the others.

The patien t j ust l ived 100 hours from the commencemen t of the attack 5 mind perfectly clear tothe las t.R EMARKS — The only benefi t that treatment had

given in th is case,which the autopsy revealed

,was

the rupture of the lower encircl ing lymph band.

The quantity ofwater (two gallons) passed up atone time

,in order to accomplish th is

,may g i ve a

proximate idea ofthe quantity required to be ofany use in s imilar cases. I t wil l be observed that

with this quantity the ileo—caecal valvewas passed by

a suffi cien t quantity to d istend the ileum betweenthis valve and the Obstruction.

Attentive consideration ofthis case prior to andafter death has satisfied me that we have noth ingsuccessful to h ope for

,from any treatment short of

Operation,and if a second one ofth is peculiar na

ture should come under my care I shall p romptlycut down at the earl iest possible moment, afterwhich I am satisfied of the nature ofthe trouble.

i i )

that has fallen a prey to this intractable affection .AD Operation to be Ofany use must be resorted , too,

'

I s o s is ters and two brothers , (and also a son of before the lymph bands have become organ i z ed .

o

a the S i s ters) , d i edfrom In tussusceptlon . What peculiar constitutional disposit ion can th ere

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100 THE CANADA LANCET.

with the general growth . The atroph ied groups

Of muscles are improving, but the disproportion is

stil l very marked. By comparing the state Of the

patient now and at the date Ofthe Operation,it wil l

easily be seen that the change is comple te,except

i n those parts where organ ic change had takenplace ( the atrophied muscles) before the appl ication ofthe remedy. And the changes here in so

short a time have been S O great, that they give u s

reason to hope for a complete recovery in the

end.

As there was no medical treatment except such

as was requ ired to keep the system in its ordinary

health,th e change in the patient’s condition can

only be ascribed to the Operat ion rel ieving genitalirritation

,or a remarkable coincidence

A NEW METHOD OFTR EATINGFR ACTUR E OFTHE CLAVICLE.

BY HENRY VANBUREN, M.D .

, C HICAGO .

(Alsopubl i shed i n C h icago Medical 7 ou r nal . )

While one Of the visiting physician s of the Cen

tral Free D ispensary abou t three years ago, I treated a patien t for fracture ofthe clavicle, adoptingthe plan Of my friend Dr. Lewis A. Sayre, ofNewYork

,using two strips Of adhesive plaster without

any axil lary pad. I became convinced at once,

that the principle advocated by Prof. Sayre, was F igure I . VanBuren’s first Bandagefor Fractured

undoubtedly the correct one ; but before I had C lavicle. Back view.

gone very far in the use Of the adhesive strips, I

found that my patient,a young native of Ireland

,

began tearing them ofl'

. The weather was warm,

and,to use the language of the lad

,th ey “i tched

h im . F inding this d iffi culty in hold ing the armand shoulder back by a hitch around the body

with adhesive plaster, the thought struck me, that

I would make a hitching post ofth e sound shoulder instead not as in the Old plan of a figure Ofeight around both shoulders , but upon that whichI wil l now laybefore my brethren in the profession .

TO make known my plan in a sentence— I make

attachment to the middle of the arm on th e frac

tured side draw the arm backward until the clavi

cular portion ofthe pectoralis major muscle is putsuffi cien tly on the stretch to overcome the sternocle ido-mastoid

,and then make a hitch ing post of

the sound Shoulder to hold these muscles in exten

S ion, and by th is extension with the sl ing, which

will be hereafter described , the ends ofth e fracfured clavicle are held in apposition. I make the

first bandage three or four inches wide out Ofnubleached cotton , Ofdouble th ickness and sufli cien t

l ength . On one end ofth is bandage a loop ismade

,by returning the bandage on i tsel f

,and

fastening the end with a few sti tches The hand

on the inj ured side is then passed through th isloop

,and th e loop carried up to a point just below

the axillary margin . This bandage is then passed

directly across the back,and under

'the sound arm

and over the sound Shoulder, and returned oh

liquely across the back , and pinned or sti tched to

itsel f at the point where the l oop is formed . See

figure I .

The second bandage is then made and appl ied

as fol lows Flex the arm Of the injured side,and

place the hand on th e ches t,pointing in the d irec

tiOn of the sound shoulder ; then take a “piece Ofthe same material “as used in the firs t instance

,and

make a bandage four inches wide,Of double thick

ness and suffi cient length,and pin or

'

stitch one

end ofthis bandage to th e lower margin ofthefi rst bandage, in front ofthe sound shoulder. I t

is then passed diagonal ly downward,and across the

ches t under the hand and forearm which has been

flexed upon th e chest, and carried around the arm

at the elbow, and back on the dorsal surface oftheforearm and hand to the poin t fromwhich i t started, and th is end also pinned to the firs t bandage.

The lower margins ofthis bandage are then st itched together for a distance Of about three inches at

the elbow, thus forming a troughfor the elbow to

THE CANADA LANCET.

The same is also done at the upper end

bandage,which forms another short trough

the hand to rest in. See figure 2.

Figure 2. VanBuren’s second Bandagefor Fractured

C lavicle. Fron t view.

This bandage or sl ing may be made as described

before it is appl ied , and the elbow placed

lower trough and the hand in th e uppermd the upper ends of th e bandage pinned

same may

ound th e arm ofthe inWhat is presented

,then

,

f the profess ion in th is me

l ici ty Of the appl iance.reten tion ofthe fragments

ve ease with which the band

takes place in fracture ofknown to require any de

shoulder fall s downward,

end ofth e

acromial portions ofthe clavicle. The indication s

to be fulfil led in the treatment are also well known,

viz : to draw the shoulder upward,outward and

backward,and retain i t there , and thus by virtue

of this position,hold the fractured ends in appo

sit iou . I t wil l be Observed that the fi rst bandage ,as presented in F ig. 1 , not only draws the Shoulder

backward, but has a l ift ing tendency , th e bandage

being at a higher poin t,where i t passes over the

sound shoulder than where at tached to th e arm on

th e injured side , hence the shoulder is drawn up

ward also that the del toid and biceps muscles are

quieted by the loop around th e arm . Let the sur

geon h imself stand erect and thrust backward and

upward h is own shoulder,th e one supposed to be

the inj ured one,and flex the fore-arm upon the

chest,with the hand poin ting in the direction of

th e sound shoulder,and he has at once secured

the posit ion and fulfil l ed al l the indications desired

in fracture ofthe clavicle ; and the bandages presented in th is paper retain th is posit ion in a very

simple and practical manner.

A patien t ofmine under treatment for th is inj ury

,was brough t before the Chicago Medical

Society,at one ofits regular meetings in May last,

after union had taken place ; and I th ink thegentlemen who were present can say that there

was l ittle or no deformity in the case before them .

I also had the privilege Of doing what was so much

desired before submitting this paper for publ ication ,that ofbringing th is method before a number ofsurgeons Ofhigh standing in the profession , at th elate meeting ofthe American Medical Association ,among whom were Dr. Lewis A. Sayre, of New

York ; Drs . Gunn and Powell , of Chicago ; and

Drs . Bridge and Hyde , associate ed itors Ofth eC hicago M ed ical y ournal, who approved ofth eplan laid before them . I was eagerfor the opinion Of Prof. Sayre, who was the first to put into

practice the principle laid down in th is method ,and th e plan received his hearty approval . I have

treated every case offractured clavicl e upon th isplan

,which I have been called upon to attend

for th e past two years , modifying the appl iancefrom time to t ime , until th e indicat ions sough t after

were more perfectly acquired . At the beginning

of the third week, or earl ier, the bandages should

be removed occasional ly, and passive motion ofth e elbow and shoulder made. I am of the Opin

ion that j udic ious movement ofal l fixed joints is

THE C ANADA LANCET.

too long delayed by most surgeons in Ca'ses Offrac

ture. In the fracture presented in this paper, with

the bandages used, early movement is in d ispen

sable, inasmuch as the parts are held so completely

at rest.

And now,i f any apology is needed for trying to

present a new way oftreating this fracture , i t mustbe found in th e fact

,that we think the O ld plans

were failures,notwithstanding the many and com

plicated means devised to secure reten tion . Dr.Sayre has quoted

,in h is pamphlet on th is fracture

,

from a doz en authors,running back to the days Of

Hippocrates, showing that th is inj ury has always

been attended with deformity. In Prof. Hamilton ’s work on

“ Fractures and Dislocations,

” th eanther quotes from fifty-seven different authors , tosustain his own Observations

,that this fracture is

n early always followed by deformity. Miller,Fer

guson, Simpson , Hancock , South , and many OthersofEngland , and a grand array in other countries ,have all had their wedge-Shaped pads, and never

ending turns ofthe bandage around the body,bu t

I cannot see that they accomplished more than_to

keep the fracture quiet, and thus facil itate a kindofun ion with , as they al l acknowledge, more orless d eformity.

South says that he does not l ike any apparatus“

which draws the shoulder backwards . I f the author means both shoulders , we are agreed but Iwant one shoulder, and that the inj ured one, drawn

backward , and well backward at that,— for herein

we get extension and counter-extension too,if you

please,th e thing so essential infractures Of all long

bones,and we cannot get this in any other way.

The pad under the arm does not causea dequateextension , nor will i t ever do S O

,no matter how

large or in what manner placed. The figure of8bandage Of modern use

,i s exceedingly obj ec tion

able,for one important reason , i f for no other. I f

the fracture is in the middle third ofthe clavicl e,

or near the middle at all , the bandage presses down

over the site ofinjury, and particularly over theinner end Ofthe outer fragment

,the very end al

ready dragged down by the weight Ofth e shoulder

,and just here is one ofthe valuabl e points in

what we have termed a new method . The inj ured

shoulder i s entirely free from any depressing or

other bandage. I do not even allow the patient towear a suspender over the injured shoulder.

The “ pos tural position ” might do quite well for

TR ANSLATIONS FR OM FOR EIGN JOURNALS .

MOD .

EPILEPS Y CAUS ED BY A LARGE FIBROMA OFTHE

an indolent man , but even then we migh t fail ingetting union ; again, this is an age of fresh air andhygiene

,and every patient

,as far as practicable,

should have the advantages ofout-door exercise .I am no stickler for any kind ofapparatus in thetreatment offractures, any more than I would befor any particular medicine in disease. Whatever

accomplishes the end in the most simple mannerunder exis ting circumstances

,is generally

,i f not

always , the best, and the plan for treating fractures

ofthe clavicle,as presented in this paper, i s in

keeping with th is doctrine,ari d is brought before

theprofession with confidence,and in the belief

that a good result can be attained in the hands of

any surgeon,i f the method i s faithfully and in tel

ligen tly carried ou t.

PO I SON ING BY SALIC YLA’

I‘

E or SODA. Dr.

Peterson (Deufsche Med . Wochenschr if) mentionsa case in wh ich sal icylate of soda was given by

mistake to the extent Of26 grames (390 grs. ) in 1 2

hours . The patien t was a young girl about 1 5

years ofage, who had been Operated upon for resection of the ankle j oint. Fourteen days afterthe operation

,she was given the salicylate ofsoda

as above stated,and very soon toxic symptoms

manifested themselves,similar to those observed in

experiments on animals. The brain symptoms

were'

the most prominent and persistent. There

was del irium,diffi cul ty of h earing and ringing in

the ears she was perfectly rational at times, and

then complained of severe h eadache ; could not

see distinctly at a distance . There was strabismus

and extreme mydriasis. The del iri um lasted 8

days and was ofa melancholy nature. During

this time she had no recollection ofwhat transpired.

The temperature was not affected . There was

hoarseness for four or five days ; the respiration

increased to 40 per minute, and the skin wascovered with a profuse perspiration. There wasconsiderable disturbance Of the vaso-motor sys

tem ,and dilatation of the blood-vessels in different

parts ofthe body was noticed.

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104 THE CANADA LANCET.

that in pyaemia a free opening is preferable to all

other methods.

In serou s exudation he thinks thoracentes is is

not required if th e fluid extends -no higher than

th e'

middle ofth e scapula but that that i t wil lbecome absorbed without danger to the pat ient.I f on th e other hand one side ofth e ches t is fi l ledand there is pressure on neighboring organs

,an

immediate operation is called for. When the fluid

accumulates slowly he would not con sider i t toolong, to wait two or three weeks to see if absorpt ion w il l not take place spon taneously. He con

siders it advisable to ascertain as soon as possibl e,

however, whether the exudation is serum or pus .This may be done by means ofa hypodermicsyringe. I f blood is found to exist i t indicates anunfavourable

.

case ; th e prognosis is bad. The

author al so alludes to the fact that thoracen tesis

for the most part not serious,is not entirely free

from danger, especially in persons who are weakened by long continued disease.

HYPODERM IC INJEC TION OFERGOTIN IN HE

MOPTYs Is .— Dr. H irschfield ( I/Véz

'

ner M ed . Pa sse)after alluding to the use of cold in the form ofice

,

alum , acetate ofl ead, tannin , chloride Ofi ron , &c .

,

says the sovereign remedy for hemoptysis is thehypodermic use ofergotin , which acts as a vasoconstrictor. Drasche was the first to use ergotinin this way in 1 8 7 1 . I t is rapid in its action

,and

easily introduced as compared with the inceptionofmedicine by the stomach under such circumstances . I t i s administered in solution with glycerine r to r e . To prevent any irritation byreason of the puncture

,and to allay i rr itabi lily of

the nervous system frequently present in hemorr

hages, and procure rest, he precedes the inject ion by one ofmorphia

,or adds morphia to the

solution of ergotin .

d urrzavuuamre.

To the Edi tor ofth e C ANADA LAN CET.S IR -With reference to the no te in your last

issue from my esteemed friend Dr. Daniel Clark ofthe Toronto Lunatic Asylum , claiming priori ty in the

Operation ofhysterotomy in Canada,I must

cheerfully concede that claim, qua ad myself. Dr.

Clark’s Operation preceded mine several years— the

one performed by me being on the a8th September,1 8 7 1 .

Your obed ’t servant,WM. H . H INGSTON .

MONTREAL,Nov. 6 th, 1 8 7 7 .

sawed guid es.

TUBER CULAR MENINGITIS.

This disease is usually spoken Ofas one chieflyconfined to children , though most authors recognisei t as occurring in adul ts , but as rare in them . Themost recent text-book (R oberts) teaches studentsthat though mostly seen in children between twoand ten years Of age, i t may be met with fromearl iest in fancy to old age. A verv good descript ion is given by Dr. R oberts, in which it i s manifest that h e is writing from it affecting ch ildren .

Then he turn s to th e disease in adults, and saysthat i t i s u sually considered as secondary , thoughGee th inks i t as common pr imary .

The symptoms are said to resemble those oftheaffection in chi ldren ,

themost prominentbeing severefrontal -headache, with darting paroxysms . heat ofhead with redness offace

,or al ternate flushing and

pallor with suflused conjunctivae ; Often dulnes sand mental confusion

,tending to somnolence or

stupor alternating'

wi th delirium ; indisposi tion tospeak , sometimes sudden aphonia ; photop hobiaand in tolerance ofsound twitch ings , ptosis, or

other evidence ofi rritation ofth e cranial nervesconvulsion

,paralysis

,cerebral vomiting coma

follows .Such are th e ordinary symptoms , but they vary

much in different cases. Hence the disease , vervfrequently, i s not recogn ised during l ife. The textbook we have cited contains as much as may beexpected to be known to the majori ty ofpracti tione rs . A much more elaborate account of our

knowledge on the subj ect has been g iven by

Huguen in in the twelfth volume ofZiemssen ’s“ Cyclopaedia , the Engl ish edition Of which hasbeen d uly reviewed in 7 7 mDoctor . There we finda series Of divisions ofthe pathological appearances

,some ofwhich migh t have been studied to

advantage in reference to the defence in the Pengecase.The development ofsymptoms is usually said to

follow a defini te order,and authors Often speak of

th e three stages— 1 , brain irri tation ; 2 , pressure ;3 , paralysis. In a typical case this order may befollowed bu t typical cases are rare, and moreoverthe d isease is insidious in its attack, .and not alwavswatched throughout. There are many other d ifficulties . Cases are

,in our own experience , apt to

be very"

obscure,and we may state on th e authority

ofHuguen in,that “ m i l iary tubercles may be de

veloped in ti le p ia mater w i t/zout a s i ngle symptomdur i ng l i e leading us to suspect t/zei r ex istence.

Those whose attention has been roused by theP enge case to renewed interest in this diseasewould do well to reconsider i t from the point ofview which preceded that case. They will thenbe prepared to more critically consider the state

THE CANADA LANCET.

were found,and also adhesion of the pia and

brain . These were attributed to previous inflammat ion , and i t was remarked that no appearanceofrecent inflammation , such as lymph or effus1onin to the ventricles , was present. There weresome small patches ofrough millet-seed l ike deposi t in the meshes ofthe pia mater

,probably

tubercular. This description,together with the

symptoms Observed at . the close of l ife, laid thefoundationfor the defence, and there can be no

of Drs. Bristowe andertain ly to death fromrise to the subsequent

evidence in court, has since publ ished some important remarks on the case in the Lancet

,and to

his paper we shall now turn,merely observing that

Mr. Wilkinson denies in the same j ournal the exis tence of adhesion.

Dr. Greenfield cites the symptoms observedduring l ife— drowsiness passing rather rapidly intocoma

,with stertorous breath ing

,rigidity ofone

arm,and extreme inequal i ty ofpupils— as point ing

to cerebral disease. He adds that “ the presenceof m il iary tubercl e in the pia mater

,even if in

smal l amount, as seen with the naked eye , is itsel fa sign ofvery serious cerebral disease

,

” and thati t is neverfound after death in cases wh ich havenot presented cerebral symptoms during l ife.” I nsupport of th is last statement he refers to Bristowe

,

Murchison,Payn e, Wilks, and Moxon , but although

he afterwards quotes Huguenin he does not seemto have noticed the remarkable passage we havecited above in ital ics. He says

“ In the rarer form oftubercular meningitis,in

which the tubercle exis ts on ly on the convexity ofthe brain , there is an absence of lymph exudationat the base, and ofhydrocephalus and there maybe an absence of exudation on the convexity

,and

of softening ofthe brain-substance a condit ion ofextreme engorgement of the superficial veins, ofgeneral in tense reddening of the pia mater

,and a

very vascular condition ofthe subjacent cortex,

w ith more or less of the wh ite matter,be i ng the

o nly sign of early inflammation visible with th enaked eye. This also res ts on my own Observat ion, and the statements ofauthority (Huguen inand Gee) .I n th is form tubercular meningit is ofth e

convexity ’

) death IS usually much more rapid thanin the commoner form (Gee) . Even in the common form the amount ofhydrocephalus and ofb 'ain-softening is very highly variable, and theiramoun t bears no definite proportion to the severi tyofsymptoms or rapidity ofcourse. When chron icbrain disease exis ts the changes in the brain and

2

105

the

)

symptoms are often greatly modified (Haguen1n

The onset of tubercular meningitis in the adul tis Often much more sudden and unexpected thanin th e child

,and

,in my experience

,the disease i s

more rapidly fatal , in some cases only from twentyfour to thirty-six hours elapsing between the defin ition ofthe disease and death .

“ The symptoms oftubercular meningitis, prO

tean even in the child , arefar more so in the adult,in whom they may simulate almost any form ofcerebral disease. Drowsiness passing into comamay be the only symptom observed (Bris towe ) .Precise distinction between the symptoms ofmeningitis ofth e convexi ty and ofthe base i s not possible in al l cases. In some cases ofthe former thesymptoms closely resemble those ofmen ingea lhaemorrhage.”

After th is passage, wh ich we have given textually,Dr. Greenfie ld examines the several symptomspresented tn th e Penge case at considerabl e length .

It IS unnecessary for us to follow him through thesedetails

,as they concern other poin ts in the case .

At present we are occupied with tubercular men ingitis

,and of this disease Dr. Southey (B r i t. Med .foam ”October 20 , and 2 7 ) relates several cases

which aptly illustrate some of its aspects . He hadpreviously collec ted a considerable number withreference to some points ofstat is tics. He findsthat “ the disease, as we advance in l ife, i s lessfrequent, and the symptoms are far less distinctthan in childhood . In adults th e disease beginsand pursues its fatal course with s ingular insidiousness, and is frequently misunderstood , even by ex

per ienced medical men un til the autopsy revealsi ts true nature .” This opin ion , i t will be observed ,exactly coincides with that we have above expressed

,and corroborates the statement of Huguenin .

Some of these cases very aptly illustrate the d itficul ty ofd iagnosis (one was received as typhoid) ,the general secondary nature ofthe men ingeald isease

,and other important points. In one mos t

interesting case the true diagnosis was announcedin spite of some spots thought to be poss iblytypho id

,founded only on vom i ting

,head 1che

,

nape-pain, prior spinal d isease, suspected to bestrumous ; temperature 1 0 1 6 in the evening

,and

1 00 8 i n the morn ing ; no symptoms oftyphoidexcept continued fever and del irium at night, andno pneumonia. There is much in the manner Ofsuch patients, th e attitude, and other circum stancesto suggest cerebral m ischief, and , so far as description goes, th is seems to have been the casehere

,and there was the prior sp inal d isease. This

would suggest struma , wh ich, as all will remember,is the most fru itful source of tubercular men ingit is .

106 THE CANADA LANCET.

R ECENT CASES OFPAR ACENTESISTHOR ACIS.

Dr. George H . Evans (Clinical Society ofLondon) , read notes of three cases of pleural effusionwhich had recently been under his care, in whichhe had performed paracentes is thoracis, and whichcases seemed to illustrate some ofthe advantagesof that Operation. 1 . 1 . A groom ,

aged 23,was

admitted in to Middlesex Hospital on Apri l 24th,1 87 7 . H is previous heal th had been good. Threeweeks before admission he caught C old ; sixteendays before admission

,he had fel t pain in the righ t

side of his chest,and had become short ofbreath.

On admission his temperature was deg ; therespirations were 36 . The right pleural sac wasobviously ful l of fluid. O n April 26 th

, paracent es is was performed with C oxeter

’

s aspiratingsyringe, and seventy-two ounces ofclear serumwere removed. He improved rapidly in health

,

and was discharged recovered on May 18th. 2.

A saddler, aged 29, was adm i tted on September6 th

,1 87 7 . He had caugh t cold in November

,

1 8 76, was then in bedfor four months, and had nots ince been fi t for work. O n admission his temperat ttre was deg. the respirations were 20. Therigh t lung was healthy ; the left pleural sac was ful loffluid . On September 7 th, he was puncturedwith C oxeter’s syringe ( the syphon action onlybeing used ), and thirty-five ounces of rather cloudyserum were removed . Fat globules were foundund er

'

the microscope in the flu id. He progressedrapidly to health , and was discharged convalescenton September 26 th. 3 . A porter

,aged 3 2 , of

previous good heal th , was admitted on May'

24th,1 8 7 7 . His illness had commenced in December

,

1 8 76 , with pain on the left side. On admission,

the left pleural sac was ful l of fluid , which hadprobably occupied it for some months. Temperature 985 deg. ; respirations 3 2. He was tappedon May 1 6th, in the seventh interspace (C oxeter

’

s

aspirating syringe) , but only fifteen ounces of serumwere removed. On June 9th, he was again tappedin the next interspace above, and fifty-five ouncesofclear serum escaped. He then gradually improved in condi tion, and seemed to be doing well,when Dr. Evans ceased attending the hospi tal atthe ‘ end of June . On July 24th he was dischargedrelieved, and made an out-patient; 011 Dr. Evans’sreturn the man was attend ing as an out-patien t ;and

'

on August 1 5 th h is left chest was found to befuller than before. Being re-admitted on August1 6th, he was tapped on the 1 7 th, and fifty-fiveounces ofserum were removed, with immediateimprovement in the condition of his chest. Hegradually improved in heal th and condition, withoccas ional suspicious s igns at the upper part of theoverworked right lung

,which

,however

,had all

disappeared, so that he was now convalescent, andrapid ly gaining health and weight. Dr. Evans t e

marked that, having been for some years a strongadvocate and . adm irer of th e Operation

,he had

been surprised to hear ofand to read lately O bser

vations of much Older and more experienced phys icians rather in disfavour of the operation than

otherwise. O f course he must admit that, in manycases Ofeffus ion ofserum into a plueral sac , thefluid disappeared without be ing artificially removedbut he believed that nobody would deny that thisprocess involved usually a considerable amount oft ime, during which almost absolute rest was anecessary part ofthe treatment. Now he couldnot see why one should not considerably shor tenth i s interval by an Operatton of a very simple and ,as far as he had been able to ascertain, harm lessdescription. He believed that the old doctrinesuggesttng that the adm ission of air into the cavityd uring or after the Operation would probably leadto the ser ous effusion becoming purulent was now

exploded . At all events,he had never seen or

heard ofsuch a case,though he knew of certainly

one and probably two case s in which the delay orneglect ofparacentesis had been followed by achange from serum to pus

,indicated in the one

case , which he had fol lowed throughout, by a rigorand afterwards a constant hectic temperatu re.As to the advantage of shortening the period during which fluid remained in th e chest , one of thecases, No. 2 afforded an instance. The day before he was seen by Dr. Evans, he had, by the ad

vice of his medica l attendant,consul ted an em inent

hospital physician,whose advice was to the effect

that he should res tfor a month and then see himagain , with the view ofsome action being taken incase the chest should be stil l occupied by fluid.

Owing to the advice ofa friend whom he met inthe street

,he came as an out-patient to the Mid

d lesex Hospital,where

,being admitted

,he was at

once tapped,and in three weeks afterwards sent

out in good health.

Dr. Cayley referred to the frequent occurrenceof tubercle i n cases of hydrothorax, the tubercledeveloping in the lung the pleura ofwhich hadnot been attacked by the inflammation. He conconsidered the cause ofthis to be the protractedhyperaemia, and that an early removal of the flu idby lessening the hyperaemia would l ikewise l essenthe chance oftuberculosi s.Dr. Williams referred to the advantage of early

aspiration, and said he had never seen evil resul ts

from the Operat ion.

Dr. Southey said the profession would greet anyexplanation ofsymptoms by which a l ine migh t bedrawn so as to at once determ ine tn what cases Ofserous effusion the fluid should be evacuated.Often fluid was absorbed in a few days

,and surely

in such cases the operation was unn ecessary. Hewould not ad vise tapping of the chest unless theeffusion had remained long in a chronic state, orshould the disease be still acti ve, not unless

https://www.forgottenbooks.com/join

.108

has been passed since adm iss ion,and there does

not appear to be any in the bladder. Three enemata have been given but with no effect. The

abdomen is now sl ightly fuller than yesterday,bu t

entirely free from sign of distension,and no appear

ance of distended co i ls Ofintestine . Pain has nowentirely ceased ; but on pressure there is tenderness in exactly the same position as before. Noother change i n the physical s igns, and no drawing ti p ofknees. R eflex verm i cular movements nottoo readily exci ted.

At 3 P. M . Dr. B ris towe kindly saw the patien t,

and advised an operation . Ether having beengiven

,a median incis ion was rap idly made through

the abdom inal wall, nearly three inches in l ength,the umb il icus be ing in the centre ofi t. Afterd iv iding th e peritoneum on a director

,a coil of

distended small intestine came into view ; thi s wastraced downwards, and a constrict ing band almostimmed iately discovered a l ittle to the left, andbelow the umbil icu s, apparently connected with themesentery . I easily tore th is through with thefinger

,and a strangulated loop ofgut, wi th the seat

of constrict ion deeply marked on its surface verydark purple i n colour, b ttt Ofglis ten ing surfaceappeared in the wound. The intestine d id not protrude

,there was no d iffi culty in th e operation

,and

the seat ofconstrict ion was discovered withou t delay. S O far as the surgical procedure was concerned

,i ts aim was most speed ily and successfully

accompl ished,but the patien t d ied before he could

be removed from the Operating table . Artificialrespiration and intravenous inj ections with otherres torative measures were tried for some time butw ithout effect.A post mor tem examination was made at 9 A. M .

August 7 th , ten hours after death , by M r. MacCormac and myself. O n opening the abdomenthe upper part was seen to be occupied by slightlydistended coils of smal l intestine, the omentumbeing slightly drawn up to the righ t side . O ccu

pying a pos it i on just below and to the left of theumbi licus an in tensely congested loop ofsm al l i htestine

,which

,when unfolded

,and seperated from

the mesentery measured about six inches. At eitherend of this loop was an obliquely transverse palel ine the mark of the constrtction . The s trangu

lated loop was ofdark purple colour, from intenseconges ti on , but not yet slough ing, i t fel t thickened ,firm

.and fleshy compared with the rest of the

bowel. The correspond ing portion of, the mesen

tery was also intensely engorged , and there wereecchymotic patches i n other parts Of mesentery adjacent. O n close inspect i on very sl ight l nc i p i ent peritonitis was seen in the neighbourhoodonly of the strangulat ion . The peri toneal cavi tycontained about 2 ounces of port-w i ne-colouredflu id. Th e small in testine below the seat of stran

gu lation was contracted and empty, but not tightlycontracted or notably pale ; that above was d is

THE CANADA LANCET.

tended and fill ed (as also the stomach ) with thinpeasoupy fluid of ordinary s tercoraceous character.011 very careful search no sign ofthe constricting

band could be d iscovered . Som e portions of theomentum looked th icke ned and pink ish

,and as if

torn across, btt t no other condition could be foundto giy e rise to the strangul ation . On removal andOpen i ng Of the bowels the upper extremity ofthestrictured portion was fou nd to be exactly six feetfrom the pylorus. The whole o f the tissues ofth estrangulated loop were intensely gorged with bloodthe valvulae conniven t e s especial ly engorged, andpresenting some superfici al erosion ofthe mucousmembrane, form ing yellowish-white l ines.The case il lustrates very forcibly th e importance

of operating as early'

as possible when the natureof the case is decided or probable. But s ince inall such cases the d iagnosis both of the nature andseat ofthe Obstruction are of the highest importance, I may brie fly d is cuss the grounds on whichthe diagnosis was based.

Pain .— It is wel l know 11 that the pain in intes

t inal obstruction if the obs truction be at all acu te,is usual ly referred to the umbil ical region whateverthe seat of the lesion . But here we had to do notwith an ordinary pain

,but with distinctly localised

pain, increased on pressure,and made to recur by 1

pressure after i t had nearly gone. The posi t ion ofthis pain , and of the apparent slight swell ing wh ichaccomp m ied it, rendered it probable that ne i therthe lower part ofthe ileum nor the ileo-coecalvalve were involved.

Vom i ting— The early occurrence of vomiting is

related perhaps rather to the suddenness and severity ofthe obstruction than to its posit ion . Butother th ings being equal

,early and. severe vomit

ing is more likely to occur when the obs truction iss ituated high up than when low down . But ofperhaps greater importa nc e is the fact that thevom i t became very scanty even before admission ,and that its characters were not those usually observed when the lower part ofth e smal l i ntestineis the seat of obstructio n and that supposing thestrangulation to have been sever e enough ‘ to causeso early vomiting, the other symptoms would bythat time have been much more severe.S upp ress ion ofU r ine has ’

often been regarded,

s ince Dr. Barlow firs t dr ew attention to it,as a sign

ofthe high posi tion ofthe obstruction. The viewwhich is now more commo n ly advocated

,and which

is endorsed hy'

Dr. Bristowe in'

his article in'

R eymolds “ System of Medicine, is that suppression ofurine is rather a sign ofsevere and sudden Oh

struction . I t would therefore be presumptuous inme tooffer any opinion against such distinguishedauthority but I must confes s to a bias towards thebel ief 111 the accuracy of Dr. Barlow’s observati onswhatever explanation may be given of th e facts .Thus much I may add, that I have never se en,either in strangulated hernia or in intestinal ob

THE CANADA LANCET.

struction,so complete a suppression ofurine as in

the present case, nor have I ever seen an obstruetion so high up in the bowel . I t has appeared tome that wh ils t suppression or retentionfor twen tyfour to forty-eigh t hours i s not uncommon whenthe obstruction is low down in the smal l intest in eor in the caecum ,

sigmoid flexure or rectum there ISvery rarely any actual suppress ion for so long or atso late a period as in the present case.

0

But by far the most valuable and decisive ind tcation ofth e high posit ion ofth e Obstruction wasthe almost entire absence ofgeneral swelling oftheabdomen and of visible distension ofcoils ofintestine . This was indeed so remarkable thatdoubts were expressed by good and competentobservers as to th e real ity ofth e obs truction , th eywere incl ined to consider that the vomiting wasdue to col ic or some other cause when the pat ientwas admitted — Tin P rdctitioner .

SYME ’S AMPUTATION AT THE ANKLEJOINT.

BY E. D. HUDS ON,M.D.

,NEW YOR K.

The amputation at the ankle-joint ( t ibio-tarsal )originated by Mr. Syme is one of the tr iumphan tach ievement s of the art of surgery for the cause ofhuman i ty. It i s an Operat ion wh ich perfects thesurgery of the inferior extrem i t-y , and one wh ich i sfree from the d isadvan tages and defects pertainingto nearl y all amputat ions of the foot and leg.

The h istory ofth is ampu tation (Syme ’s ) duringthe past twenty-five years

,as performed by scien t ific

and expert su rgeons,affords conclusive ev idence

ofi ts advantage to the patien t,and demon

strates i ts superiori ty in conducing to comfort andusefulness to every other amputation of thefoot or leg . I t i s the least d isabl ing

,.the least

in capacitat ing, and with scient ific prothet ic apparatus the pat ient scarcel y real izes any loss of l imb .

The end of the stump is painless and an endur ingbas is ofsupport

,rel iablefor any degree ofpressure

and service, and equ ivalent in cond i t ions and funct ions to the heel ofthe unamputated foot.The merits ofa well -performed Syme’s amputa

t ion can not be exaggerated. The subj ect of th isoperation s imulates the whole man more perfectlythan the subject of any other. I am able to sustain th is assertion by tabulated records of two hundred cases , of wh ich I have personal notes.My fi rst Observation of ankle-jo int amputat ions

,

and exper ience in adapt ing apparatus thereto,was

i n the year 1853 . I was requested by Dr. J , M .

C arnochan, Surgeon-in -Ch ief of the New York S tate

Em igrant Hosp i tal,to give my attent ion to the fi rst

case ofankle-joint amputat ion performed i n th is

coun try by the doctor upon one ofthe hosp ital pati en ts. Dr. C arnochan had but recently retu rn edfrom Edinburgh , where he had been a pupil of Mr.Syme

,and had become acquainted with h is improv

ed amputation at the ankle-j o int and h is mode ofperform ing i t. I exam ined the case w i th pre

j ud ice and as a cri t ic,regard ing i t a bold and doubt

ful innovat ion,a departure from the best author i

t ies ou surgical pract ice but the anatom icalconstruct ion of the s tump, i ts pathological condi tion ,and i ts capaci t ies for future usefulness w i th su itableprotli etic apparatus, impressed m e most favourably .

The immed iate and the permanent results ofthatfirst case were al l that could be des ired.

In 1854 Dr. S tephen Sm i th , Surgeon to Bel levueHosp i tal , performed the second operat ion i n th iscountry ofSyme’s amputat ion at the ank le—j oint ona girl at the hosp i tal . I was present by inv itat ion .

It was a marked success an honor to the surgeonand an inest imable benefit to the patient. S he

subsequently acted as a nurse in the wards , and wassuspected by butfew to be the subj ect ofan ampatat ion . This was the famous Kate R iley case re

ported in the New York Med ical Journal at thatt ime. H er walk and appearance

' in every respectwere n atural , and she experienced nei ther pain norunusual fatigue. The most host ile and skepticalwere si lenced.

These two cases ofoperation at the ank le , and thesuccessfu l and mod ified amputations at the kneej oint as rev ived and performed by D r. Markoe

,

erad icated my prej ud ice against j oin t-amputations.The on ly deduct ions from the facts and cases p resen ted were that the operat ion was suzfici ent ; thati t should be performed whenever the ci rcumstanceswould perm i t that i t should be the preference ofthe surgeon in every instance of amputation of thelower ex trem ity when he has the choice ofs i te,whether a favourable or unfavourable cond i t ion ofthe t issues supply ing the flap covering the end ofthe stump ex isted.

Every day ’s observation and experience during theper iod oftwenty-four years has confirmed my j udgment of the w isdom and benefits ofthe Syme am

putat ion,as demonstrated by the subj ects. Of some

two hundred cases oft ibio-tarsal ampu tat ion afterMr. Syme

’s method,or as modified by retain ing

the art icular surface of the t ib ia, w i th wh ich Ihave been concerned in consul tat ions, operat ions,and ul timate reparat ive treatment w ith compensat ive prothet ic apparatus

,al l

,w i thout an except ion ,

have resul ted e i ther immediatel y or remotely an en

t ire success. Somefew,e i ther by reason of the ex

ten t ofdisease,inj ury

,or shock

,or other events

to wh ich Surgical cases are exposed, underwentslough ing and healed by secondary in ten tion , butin the end invariably y ielded good stumps and sol idbases of support. They were free from any degreeof i r i tability , tenderness, abras ion , or ulceration ,and proved eminently more serv iceable than would

THE C ANADA LANC ET.

the same n umber of cases of ordinary amputat ion tens ive cri tical observat ion convince me that the

ofthe foot or leg ti bia-tarsal, or Syme’s method, i s the most useful

The invar iable u ti l ity ofthe Syme stumps has and wort/zg— Louz

’

w i lle Med . Times .

demonstrated the physiological capaci ty of the baseofsupport wh ich i t g ivesfor any amount of serv iceand weight. A gentleman suffering gunshot inj uryof the foot

,and undergoing Syme ’s amputat ion at ON R UPTUR E OF THE MEMBR ANES IN

the hands of Pro f. W . H. Van Buren , has repeatedly LABOR .

walked th irty m i les continuously, upon gunn ingexcursions

,w i thout his compan ions suspecting the

defect in h is l imb. O ne of the earl iest subjects o fMr. Syme’s amputat ion v is ited me

, s ixteen yearsafter the operat ion ,for reparat ive apparatus , and re

po . ted h is stump at al l times serv iceable and rel iable.

He,too

,had travel led as far as th irty m i les i n one

day,w i th the aid of a leather appl iance, the

bucket,or shoe .

A Scotchman who had undergone a double S yme’s

amputat ion by Mr. Lister, of Ed inburgh . i n 185 9.fo r comm innted fractu re of both feet, emigrated to

this count ry i n 1869, and v is ited mefor apparatus.W i th on ly leather buckets o r cupsfor h is s tumps ,and a cane w i th wh ich to balance h imsel f, he had

subj ected h is stumps to dai ly hard usage. Final ly ,w ith the appropriate apparatus constructed to re

present the funct ions ofthe foot, h is walk was easyanal stable w ithout the use of a cane, and he has

eve r since been act ive ly engaged in agr icul ture.

No amputat ion ofthe leg or foot should be subs t itutedfor the Syme when i t i s adm iss ible, save

that ofM ay‘m nc. N0 improvement upon the Syme

method can be made by any complex mode ofOperating

,as the section ofthe cancel lated s tructure

ofthe end of the t ibia and of the calcaneumforun ion thereto. 1 have had much experience w i ths tumps so consti tu ted— method of P irogoff. Someof them have been wel l formed , and were far moreserv iceable than the stump of any leg-amputationbut where any considerable portion ofthe calcaneumhas been annexed they have proved uncouth inform resembl ing a horse ’s foot, and afford comparat ively a poor and painful base of support. Somehave resul ted in a false joint, and re tract ion ofthe appended part ; othe rs i n necros is ofthe con

t i nu i ty ofthe t ib ia a'ove the annexed portion ofthe bisected os calcis.The plea is often made that the increased length

of stump produced by the appended portion of boneaffords a supe rior advantage to the p oor man ; afalse plea however. and bet ter su i ted to med ievalsurgery . Iffor the poor man the bucket arrangement is alone available, an elas tic wool fe l t pad,hal f or five e ighths of an inch th ick , i n the bucketw il l be amply suffic ient to offset any advantagesafforded by the appended calcaneum ,

and the patientw i th the Syme s tump obtains a more even and

rel iable base of support. As an al ternat ive to themethods ofChopart

,P irogoff, or Qu imby’s mod ifi

cat ion,or a leg amputation w ith periosteal covering

of the end of the stump, a lar ge experience and ex

Dr. W il l iam S teven son , Professor ofMidwiferyin the Un ivers i ty ofAberdeen , in an article in theBritish Med ical Journal , proceeds to d iscuss thed iagnos is of the cond i t ions wh ich warrant us inhav ing recourse to rupture of the membranes beforethe ful l d ilatat ion of the os. The first point is thedeterm inat ion of the degree of expans ion of thelower uterine segment. We have seen the size ofthe external 03 i s no cr iterion of expansion . The

OS,in fact

,may be very small , and yet expan sion

may be complete. It i s by the internal os that wecan best j udge but th is is hard to reach , and d ifficul t to determ ine i ts exact s ite . There i s one means ,however, of ready access, whereby we canform aprox imate op in ion i t is the degree of d ilatat ion orupdraw ing of the vaginal cul -de-sac. This i s apoin t wh ich has been en ti rel y left out in the cons iderat ion of the progress of the first stage. I t is amatter ofcommon experience to find, in the class ofcases where wefeel someth ing is requi red to promote a labour w i th tardy di latat ion of the os, thatthe upper part of the vagina is wel l expanded anddrawn up

,greatly increas ing the percept ible dia

phragm ofthe cerv ix, wh ich alone obstructs thecontinu ity of the developed canal . Now, we knowthat the long itudinal muscular fibres ofthe vaginarun upward

,and are con t inuous w ith those ofthe

body of the uterus,and that the attachments of the

uterus i n the ir upper portion correspond w i th theinternal 03 . Th is portion

,then

,can not undergo

expans ion w i thout car ry ing w i th i t the t issues wh ichare in connect ion therewith . Consequently we findthat as the fi rst stage oflabour advances the upperpart ofthe vagina i s d ilated unti l i t seems to co

in cide pretty closel y w i th the upper part of the bonycanal . When

,therefore, a considerable port ion of

the lower segment ofthe uterus can be fel t i n thevag ina

,and not merely through i ts walls, expansionis certain to be comple te, whatever may be the size

of. the parturient r ing and the t issue composing i tare those ofthe cervix proper, and not the u terus.Under such ci rcumstances I bel ieve the membranesmay be ruptured w ith advantage. It is, however,unnecessary in many cases to waitfor the ful l developmen t of the condi t ion above described“ Ihave taken the ex treme state

,as being most readil y

understood,and ind icat ing the di rect ion in wh ich

our obse rvat ions should be made.

Another cl ass ofcases , or i t may be only an additional charac t er to those of the firs t

,are where the

act ion of th e uterus seems to be effect ing not steady

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112

Manchester,and frequently travels on the con

t in en t but continues to enj oy very good heal thin al l seasons and climes. I am , therefore , j ustified in considering him permanently cured , andbel ieve the chief remedial agents to have been theuse ofgalvanism and arsenic-inhalations.CAS E 11. W. K., ofBowdon , Cheshire, con

sulted me September 4th, 18 7 2. He was engagedin the Manchester trade , and twenty-five years old.

When a ch ild, he frequently had croupous attacks.When fi fteen

,he had gastric fever, and subsequently

pneumon i a. Three years ago , he had sl ight pleuro

pneumoma, and since that time he had sufferedfrom frequent attacks ofd ry n ervous asthma. Theattacks occurred at all times, but chiefly in thenight. Crowded rooms, sea or mountain residence,any change ofai r, would bring on an attack. Inthe intervals

,h is breath ing was free and easy

,and

he had no cough . After the attacks, he expector

ated th ick mucous discharge. H is chest wasbroadly bu ilt ; respiration was audible and clearall over the thorax ; the percussion sound wasnormal ; the cardiac sounds were clear ; th e uvulaand epiglottis were large, but ofa heal thy appearance.I ordered arseniate ofsoda inhalations

,and ap

plied daily the continuous current to both nervivagi

,in a similar manner to that d escribed 1n th e

first case. The treatment continued during amonth

,he havmg had only one m ild attack in the

beginning. I saw him lately, and he told me thathe had no attacks during nearly five years since Iattended him.

CAS E v.— Miss E. H ., ofBowdon , Chesh ire,

aged 42, has been under my observation sinceJune

,1 87 6 . She sufferedfor eigh t years from

severe attacks ofnervous asthma, and is also subject to bronchial catarrh. She used to havefrequently abscesses in th e lower part ofher back

,

but had none s ince August, 1 8 7 5. Has hadulcerated tonsils eightee n months ago. Theasthmatic at tacks came suddenly in her sleep

,gen

erally between 2 :30 and 6 A M .;but any exertion

or a rich supper would bring them on . She hasfrequently pai ns in the back ofher head and neck.

Menses regular. Appetite moderate. Bowelssluggish . I saw her both during the attack andalso in the i nterval s . Dry whistl ing rat/es could beheard everywhere during an attack but in the interval, al though the breath ing was free and easy ,moist rat/es were audible in the scapular region ofthe thorax. The attacks resembled those describedin my other cases.The treatment consisted l n galvan isation ofth e

n erv i vagi , and in spray-inhalations, chiefly ofarsenic

,and also ofvarious additions at d ifferent

times,such as chloride ofammonium , t incture of

datura tatula,ozonised sea-sal t, sal icylic acid , and

cherry laurel-water. She had attacks June 3oth ,July 1 1 th and 1 3th, September 1 sth, December

THE CANADA LANCET.

CONOID CER VIX, R ESULTS AND TR EATMENT.

The external 05 is the most usual seat of th econstriction and obstruction in conoidal cervix.This arises from the pecul iar pointing ofthe infravaginal cervix

,together with an excess ive develop

ment ofthe circular fibres.0

Th e os internum is found constricted , however,in associated an teflexion . Such a malformationmay have arisen

,and ordinarily does in such in

stances,at the period of the second, the pubertic

development of the uterus.The first and most prominent symptom ofthe

conoid cervix is dysmenorrhoea. From th e natureof the malady

,we would expect the pain to be

characteristic, v iz . : expulsive, bearing down, l ike

labor-pains,preceding the flow, and diminish

ing as i t ceases . Whether it is so or not wil ldepend in part upon the quantity ofthe flow, and

4th , 1 8 76, and the last time, January 1 7 th , 1 8 7 7 .

She also had two at tacks ofacute bronch ial catarrhin September, 1 8 76, andFebruary, 1 87 7 , which Itreated with Iceland-moss poul tices applied to thewhole thorax , and the internal adm inistration ofexpectorants with belladonna ; stopping inhalationsand galvanisation during the bronchial affection .

She is at presen t in a much better state ofheal ththan for years

,and no spasmodic attack since

January last.R EMARKS .

— The treatment ofnervous asthmaby galvan isation ofth e pneumogastr ic nerves

,and

also by spray-inhalations of arsenic,seem to me to

be very efficien t, as, ofseven cases under my observation , five were permanently cured and two

greatly benefi ted. Four ofmy patients sufferedfrom nervous asthma only, and three had, in addition , bronchial catarrh . One case was also h ereditary, her father and sister being subj ect to asthmanervosum .

Galvan isation has been used with bri llihnt success for the treatment oftwo cases oftrue n ervousasthma by Dr. Althaus ( Treatise onM ed ical E lectr i

ci ty ,second edition , London , 1 8 70 , page

also by Dr. Benedikt, of Vienna, in one case

( Electrot/zerap ie, Wien; 1 868, page '309) and byDr. Brunner, ofWarsaw, in four cases lately published ( S at/r emennj a Med icine , Warsaw, 1 897 , Nos.1

Successful cures of nervous asthma have beeneffected with arsenic-inhalation s by Dr. Wistinghausen ( P etersburger M ea

’ici rzisc/ze Zci tscti r ift, 1 862,

page and also by Dr.'

Lew in ( Inhalation :t/zerap i e, Berl in , 1865 , pp . 443I am ofopinion that the two methods oftreat

ment by galvanisation and inhalation may be safelycombined

,and ensure permanency in the ir bene

ficial efi'

ects.-B r i ti slzMed ical y ournal.

THE C ANADA LANCET.

that there is no longer an obstruction , but worsestill

,the irreparable misch ief has been done.

Considering the resu l ts which may follow in any

given case of well-marked conoid cervix, really thismalformation is a very grave one, not simply so faras the monthly pain is con cerned , but also th edenial o f the procreative power ofth e patient, andstill more

,the serious inroads the local mischief

may entail upon the whole general health .

Pain may not be limited to th e menstrual t ime,but be constant from secondary compl ications, th echronic congestions and infiammations ofth euterus and i ts appendages . Fatal retro-uterinehaematocele or pelvic peritonitis may supervene.Sterility

,l ike dysmenorrhoea, i s present in the

vast maj ority ofthe cases ofconoid cervix. Thesetwo functional disorders go hand in hand.

Of the vast number ofcauses of steril ity in thefemale , perhaps there is no more common one

than th is under consideration . Fortunately , too,i t i s the most remediable, if ofnot too long duration

,and if before secondary changes have occurred

in the endometrium with chronic catarrh ; or

chronic ovari tis,with morbid or suspended ovula

tion ; or finally, atrophy of e i ther uterus or ovary.

Not al l ofth ese changes are apt to ensue in asingle case

,but such is possibl e, i f the obstruction

is sufficien t and the duration great.This operation is practiced by incising the

ce rvical .walls on either side from 03 internum

th rough 05 externum . The incision is superficialabove, but as i t extends downward is graduallydeepened . The fibrous tissue is not cu t throughand through , from out to out, in the infra-vaginalportion of the cervix as some have recommended

,

but the extent ofthe n ew opening at the base orso externum is about one-hal f inch. Allowance isthus given for contraction which necessarily followsin the process ofcicatrization . In fact, care is tobe taken that the subsequent contraction does notgo too far, wi th a return of the parts to their old

TR AU MATIC NEUR ITIS INVOLVING THEBR ACHIAL PLEXUS.

faul ty cond 1t1on . To guard against th i s , the useofthe vulcanite stern after the incision , or the occas ional passage ofthe sound is n eeded. Thisoperation has been a much abused one. Whil esubject to great abuse , i t i s a very useful one inproperly selected cases

,and if properly performed .

Compared with dilatation by means oftents or

expanding instruments,as dilators or bougies , i t i s

infinitely superior. The resul t desi red is morepromptly attained in a less painful manner, and isvastly more permanent. R eally, in cases ofth iskind, dilatation by tents, etc . ,

should be discarded.

The methods ofSimpson and Sims consist in cu tting the cervix through and through . Such precedure has a very strong tendency, i t must be confessed, as shown by Peaslee , to destroy the naturaltonici ty ofthe cervix

,deform the shape ofth e

u terus , l eaving an open , gaping os, an evertedcervical canal

,Wi th chronic catarrh

,a condition it

self ofth ings leading to steril ity ; or, i f conceptionpossibly does occur

, one favorable for abortion.

Besides, the danger ofth e operation i s material lyincreased . The only recompense for the aboveevil s i s the rel ief to the dysmenorrhoea.

There is no better instrument for this operationthan the knife ofSims

, or one with a sim ilar bladewith fixed handle . I am in the habit ofusing thelatter. All ofth e variou s metrotomes ofG reen

nalg/z, R outlz, S impson , and Atlee, with sh ieldedblades and worked by spring or screw ,

while theydo credi t to the originator and instrument makerfor their ingenuity and workmanship, are costly,clumsy, uncertain in action and dangerous in practice. The dangers of the operation performed inthe manner recommended

,unless there are special

contra-indications,are very sl ight. The results are

gratifying, usually, as to the relief ofth e dysmenorrhoea. Steril ity is not

,however

,by far so frequent

ly overcome, though success covers no small percen t. Too often the secondary changes referredto have taken place in the cavity ofthe body ofth ewomb, or in the ovaries themselves, barringrel ief to the s teril ity — D r . Palmer , C li n ic.

The following case,which was observed at the

Hospital ofthe U niversity ofPennsylvania , in th eservice of Professor H . C. Wood, is of considerble interest because ofi ts severity, pecul iar character

,and the“ favourable resul t of treatment.

J . D.,aged 32, two years before coming under

observation,had his l eft arm caugh t in a bel t and

was carried several fee t from the floor. The armwas broken abou t the wrist , the m iddle ofth e forearm, and near the shoulder. It was also badlytwis ted

,and since the accident had been entirely

114

helpless. He could not move the arm,forearm

,

or hand in any d irection . On attempting motion,

pain and v iolent tremor would ensue . He carriedthe hand in a sl ing. The l imb was somewhatwasted , but did not present the extreme atrophywhich is noticed in some cases of spinal or nervei njury.

From an irregular l ine around the arm about twoinches above the elbow, a district of highly-markedhyperaesthesia extended upward, including, whenhe was first seen , the outer part ofthe shoulder,and afterward spreading until i t embraced the leftbreas t, side , and back, in the scapular and suprascapular regions . He had constantly considerabl epain in the hyperaesthetic area

,and touching or

handling h im gently would cause extreme sufifering, and bring about fibr illary twitchings in thethoracic muscles . The pain and hyperaesthesiau sually got much worse in the even ing and duringthe n ight.From the line ofd emarcation

,two inches above

the elbow downward,the l imb was anaesthetic.

Analgesia, or lose of the sensation of pain,seemed

complete. Compass points could be jabbed intohis forearm and hand with impun ity and to thesame parts a strong faradic current could be appliedwithout causing the patient any pain or inconven ience, unless the application was so made as tojar the entire l imb. Electro-contractil ity was good.

The skin was pale and smooth-looking.

The third and fourth dorsal vertebrae becametender to pressure while the case was under noticeand when at its worst, slight hyperaesthesia waspresent on th e fi ght side ofthe spinal column

,in

the scapular region .

This patient had been subj ect to epilepticseizures for twelve years . They were supposed tohave originated from suns troke. Since the accidentto h is arm they had been less frequent and lesssevere. He had never had any form ofvenerealdisease.The treatment pursued in th is case has extended

over nearly ten months , and wil l be briefly summarized . Bromide ofpotassium was given , mainlywith the view of controlling the epileptic attacks.Iodide ofpotassium and the bichloride ofmercurywere administeredfor several weeks. At one

period he was b l istered over the dorsal vertebrae,and later the actual cautery was repeatedly applied.

Morphia was sometimes used by the mouth or

hypodermically. Galvaniz ation of th e hyperaesthetic district was employed . A weak current,usually from about five cel ls, was employed, applyingone rheophore , generally the cathode , to the cervical spine, and the other to the affected region .

The appl ication nearly always rel ieved temporarilyth e pain and hypermsthes ia.

Six months after coming under treatment th e

THE CANADA LANCET.

VOMITING IN PR EGNANCY SUCCESSFU LLY TR EATED WITH ING LU VIN

(VENTR ICULUS CALLOSUS GALLINAC EU S ) .

I was call ed to see Mrs. S . , aged 2 7 years , June8, 1 8 7 7 , who stated that she was sufferi ng from

patien t was, on the whole , rather worse than when constant and excessive nausea, which was only refirst seen

,al though he had several times temporarily lieved upon assum i ng th e recumbent posture.

improved. He was then ordered to use by inunction upon the arm and shoulder about a drachmdaily ofa prescription containing equal parts ofointments ofmercury, iodine , and belladonna.Four weeks after beginning this treatment the painleft h is arm and side, the hyperaesthesia andanaesthesia also rapidly disappearing. He steadilyimproved

,and has now,

nearly three years afterthe accident

,made a. complete recovery from the

neuritis. The motions ofthe shoulder, arm , forearm

,and hand , have all returned , and under farad

ization the muscl es are all rapidly regain ing toneand strength . Afew days after the improvementset in

,h is mouth began to show signs ofmercurial

i zation but the inunction was continued unti lwell-marked sal ivation was produced. Chlorate ofpotassium and cinchona were subsequently employed to rel ieve the ptyalism .

R emarks .-In thi s remarkable case some ofthe

great branches ofthe brachial plexus were probablyseverely injured

,by torsion

,tearing

,or pressure, at

th e time ofth e accident. The neuritis wh ich wasset up seems to have radiated to nearly all th enerves ofth e plexus , as well as to other nerves, andinvolved

,to a limited extent, th e spinal cord . The

neuritic process even appeared at one time to haveextended across the spinal cord to the righ t side.The inflammatory condition of numerous nervesand th eir branches was doubtless the cause of thepain and hyperaesthesia , while the total anaesthesiabelow can be explained on the view ofNiemeyer,that inflamed n erves are bad conductors, and henceconvey peripheral impressions incompletely, or notat all

,to the brain . Whether the cure was spon

taneous , or the resul t ofthe treatment by inunction

,the reader may j udge for h imself. For my

self,I bel ieve that i t was in great part, at least, due

to the treatment. According to Erb , the Sovereignremedy for al l th e more chronic forms ofneuri tis i sthe galvanic current ; and I have mysel f found i tof great service

,both as a pall iative and curative

agency . In the case just reported , galvan izationwith a weak current would relieve the pain andhyperaesthesia more efi

’

ectually andfor a longer timethan any other remedy ; but it was d iffi cult to carryou t the el ectric treatment with absolute regulari ty,and to include every portion of the wide neuriticarea in each appli cation — D r . M i lls , Med ical

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116 THE CANADA LANCET.

i s made rap idly and quick ly,only to be lost at each cases i n Wh ich ergo t w il l resul t in

mens trual period. It i s here des irable rather to can bO pred icted W i th a reasonablel im it the rapid i ty of the bloodformation

,so that ance — Med . Bar. Journal

, Toledo.

when the severe vascular turgescence of the menstrual p eriod comes, i t w il l n ot find the blood~vessels

too d istended w ith blood. Th is w i l l lead to d im in ished cata i nen ial loss

,and so the blood waste

w i l l be econom ised. Accord ing to the experienceofDr. Brown Sequard and Dr. Hughl ings Jackson ,i ron does n ot su it ep ileptics . It increases thetendency to fi ts. It may improve the general cond i t ion , but i t aggravates the ep ilepsy — Merl . P r essand C i rcular

THE DESTRUCTION AND EXPULS ION or UTERINEFIB R orDs BY Es cort — Dr. Will iam H. Byford,who

cont ributed to Vol . 1. Gynaecological Trans,a

report ofthree cases of u terine fibroid i n wh ich t headm in istrat ion ofergot resulted in their p i ecemealexpulsion , reports in the archi ves ofC li n i cal S urgery , an addit ional case show ing the great value ofth is agent. The pat ient was aged forty-seven, andhad for three years been the subject of severehemorrhage, leucorrhea, pain i n the uterus and general prostrat ion . Exam ination revealed a largefibrous tumor of the uterus wh ich extended to w i thi n two inches ofthe umb i l icus

,fi l l ing up the

hypogastric region and ex tend ing to the i l ium on

the left side. The u terine cav ity adm itted thesound ful ly two inches . Dr. B . at once prescribedth irty drops of Squ ibbs fl. ex t. of ergot th ree t imesdai l y, th is dose gra lually t o be increased to one

drachm. At first i t had no perceptible effect in afew days , however, the pain became so great thatthe medicine had to be om i t tedfor several days at at ime. It was resumed in smal ler doses until thepain returned too severel y

,when i t was again tem

porari ly d iscont inued. S he cont inued the med icinei n th is way unt il January 13th

,187 7 , when the

tumor began to break up and be d ischarged. In aletter to Dr. B .

,the patient describes the appearance

ofthe material discharged as“ l ike sausage meatfrom a stufi'er

,

” four inches of wh ich would be ex

truded and cut offdai ly by the pat ient. Its d ischarge was accompan ied by sharp spasms of Iancinating pains and an intolerable s tench . On the 26thof January

, the last portion was d ischarged, afterwh ich the pat ient soon regained perfect health . Incommenting upon th is case

,the author remarked

that in the intramural tumor where the neoplasmi s so si tuated that the greater portion ofthe muscular fibres surrounding i t l ies outs ide

,the pers istent

use of ergot if i t causes contract ion w ill be veryl ikely to cause i ts expuls ion .

”The constant pres

sure on the fibres wh ich l ie on the ins ide,impairs A CAUS E or INFANT MoR TALi r v.

-We latel;their nutri t ion and soon resul ts i n rupture. W i th recorded a case where we belived the death of atproper care in the exam inat ion of cases -w ith a infant had resulted from careless and mjud rcrouvi ew to determin in g the s i te ofthe tumour— the feeding. Some correspondence havrng followed i t

M U LTILOC ULAR OVARIAN Or srPREGNANC Y.

— Ersk ine Mason (N. Y. PatholSociety , ) presented the u terus of a patientwhom ovariotomy had been performed. Tterest of the case rested on thefact that therefoetus i n the uterus

,as wel l as a large ovaria

fi ll ing the cav ity of the abdomen . A numS im i laSpencer Wel ls.

spinous processes,th irty-e ight and a half inches.

The pat ient was exam ined by one of the mos

expert ovariotom ists i n the city, and was cons iders

as afavorable case for operat ion . Ovariotom

was accordingly performed , and , on open ing the abd rmen

,the trocar was passed in to one cyst, and eigh

ounces of flu id evacuated . This,un fortunately

proved to be a pregnan t uterus,and as soon as th

m istake was d iscovered the uterus was closed w itisutures and the abdom inal walls brought togetherThe pat ient passed a restless n ight , and gave h i rtlto a foetus at the six th month . Death occu rrei

eighteen and a hal f hours after the operat ion. Thautopsy revealed a large multi locular cyst ofth

‘

left ovary . There was no blood i n the cav i ty 0

the abdomen . The uterus was closely con tractedThere were no ev idences of periton i t is.Dr. Sayre said that too much cred it could n ot b

g iven to Dr. Mason for the frank manner in wh iclhe described the unfortunate issue ofthe operationand he was of the op in ion that, i f other surgeonwere equally honest in reporting cases

,many mor

would be on recordfor the benefi t ofthe professionDr. Janeway referred to n ine cases wh ich Spence

Wel ls reported, in wh ich pregnancy was found athe time of operation .

—N. Y. Med . Journal.

THE C ANADA LANCET.

soluble. Fatty food may be given with advantageonce a day

,i n the form ofyolk of egg beaten up

with milk , or mutton-suet mel ted in milk by gentl esimmering

,two ounces ofsuet being used to

thicken one pint of milk. The mixture , beingsweetened and strained

,can be taken through a

tl e. Importan t as is the subj ect ofinwe must not dwel l longer on the sub

efer our inquirers to the suggestionsr. West’s work on th e Diseases of Inin Dr. Eustace Smith ’s Cl in ical Studies

in works by other

death as i f al l food had been withe a re at the same time well aware thatdren , naturally ofa strong digestion , maythrive on almost any food — B r i t. Mea

'.

FOR THE PHOTOPHOB IA or S C R OFUBetz (M emor ioi/ien

, 7appl ication ofOpiates

that thet out wouldtreatment.keep theseowing planHe begins

117

ch ildren,two or three years Of age, just before re

tiring older ch ildren receiving correspondingdoses . Beside s this

,a compress d ipped in

cold water,and folded 6-8 t imes, i s so bound to

the face as to cover the forehead and upper partofth e face, extending at the same time well overboth eyes. I n very severe cases the compressmay be dipped into ice-water. At any rate

,the

Opiate i s the principal feature, and the dose ofth isis gradual ly increased unti l qu iet sl eep i s secured.

Photophobic ch ildren are generally restless duringtheir sleep

,turn ing and crying out every few

minutes. The Opiate controls this symp tom .

The first local sign of improvemen t is that thech ildren Open the ir eyes earlier in the morn ing.

The action of the opiate is Often so prompt that aremarkable improvement i s observed after a singleadministration

,and now and then a complete d is

appearance ofth e photophobia after afew days’treatmen t. O ther local appl ications often requ iretreatmentfor a longer t ime. The great change inth e disposition ofthe heretofore peevish and i rritable ch ild shows how much the pain produced bytoo brigh t a l ight affects the entire sensitive nervous system . To guard against relapses, Betz con

t innes the evening dose ofopium for a considerable period

,and expresses the Op in ion that the

general nutrition is improved thereby. —Allgeznei ne

Wi ener M ea’. Zei tung . C l i n ic.

DYS PAREUN IA— VAG IN ISMUS .— C llnlc by Prof.Thomas.— I present to you a case which, when

you enter practice, will be ofservice in aid ih g youto treat a condit i on which cannot be considered asrare. A point ofin terest to the physician, as wellas the patien t

,i s that, with proper treatment, a

complete cure may be effected and unfortunatelya similar prediction cannot be made in many

gynecological cases. Out of regard to the feel ingsof the patien t

,I shall run over the history. She

says that s ince her marriage any attempt at coitioncaused very severe pain , and moreover, any propos ition to that effect gave rise to severe trepidation.

When she was placed on the tabl e, and the labiadrawn,th e hymen was found to be complete. The

finger was then placed upon i t, when the patien tsuffered severe pain , s im ilar, as she says, to whatwas fel t during the efforts at intercourse. Therewas noticed

,also

,a caruncle near the urethra. Dr.

Burns,th e Scotch obstetrician , long ago recognized

the disease,and since that time may have contri

bu ted to the l iterature Ofthe subj ect. I t was,

however,to Dr. Marion Sims that we are indebted

for th e first thorough description , with method oftreatment. He called it vagin ismus. I t seemsthat there i s a hyperaesthesia around the vulva

,and

th e sl ightest pressure g i ves rise to severe pain .

The operat ion is quite s imple, and, as I remarked,offers an exceedingly satisfactory result. After thepatien t i s anaesthetiz e

’d, she is placed upon her

118

back,with the thighs separated as widely as pos

s ible. The assistants then draw apart .

the labiaand expose the hym en . This is grasped by a forceps

,and the whole ofi t removed by means of.

the scissors. Any hemorrhage is readily controlledby pressure or l igature .The Open ing Of the vulva is then further en

larged by several incisions carried downward andoutward . The incisions i n th is manner radiatethrough the perineum . After all hemorrhage hasceased

,the glass plug is inserted and retained in

position by means ofa strip of adhesive plaster,

which passes from the sacrum across the‘

vulva tothe abdomen , anteriorly. This plug should bekept continually in positionfor the first fortnight,and after that time , i t may be found that by introducing i t a t nigh t the necessary dilatation willbe kept up. After six weeks i t may be dispensedwith entirely

,and i t will then be found that the

patient is cured. I remarked,when speaking of

the examination ofthe patient, that a caruncleexisted near the meatus urinarius. I t can ' be t e

moved,without d ifii culty, by the scissors — Med ical

and S urgical R epor ter .

D I ET AND MED IC ATION 1N SAC C HAR tNE DIA

BETES .

—The best diet for a diabetic pat ient is , forbreakfast

,eggs, and any kind of meat except

oysters,gluten bread, and tea or coffee with m ilk

and without sugar ;for dinner, tomatoes, lettuce,Onions , spinach , string beans , meat, l igh t sour .wine

,and lemons

,or perhaps oranges , but none of

the sweet fruits ; supper, about the same as breakfast. None ofthe starchy foods, no alcohol, andno sugar should be allowed.

Among drugs,opium is themost valuable . Of

th is an immense amount can be taken daily without any of the symptoms ofpoisoning. I amgiving a boy now under treatment for this d iseaseseven grains ofOpium per d iem. In th is case theonly bad effect has been the production of obstinate constipation. I have known ofcases whereeven th is was unnoticed. The opium d irectly,by diminish ing al l the secretions, or more probablyby its action on the nerve centres, rel ieves the excessive thirst and voracious appeti te, and reducesthe amount of urine and ofsugar in the urine. Inthe present case the daily amount ofurine hasbeen reduced from twenty eight to eleven pints ,and the total amount ofsugar has been reducedproport ionately. Ergot, which acts in simplediuresis almost l ike a. specific, may be used insaccharine diabetes with much profit in doses ofone drachm of the fluid e xtract four times a clay.Where the skin is dry and rough, as in the presentinstance

,jaborandi is of value .by reason of i ts

great powers of diaphoresis.’

I f jaborandi be usedthe ergot and opium must be stoppedfor the timebeing — Dr. Pepper, C linic.

THE CANADA LANCET.

EPITHELIOMA OFTHE C ERV IX U TER LD i spensary ) .— Mrs. S .

, native ofI reland,forty

four years old married twenty years ; severalchildren ; last l iving child, ’

November 14, 1 8 7 2.

In June,1 873 , miscarried at six mon ths ; cause

unknown . Dec ember, 1 874, had a second miscarriage

,at th ird month ; cause unknown . Since

th is time,for more t han two years, patient

’s healthhas been fa il ing. Menstrual flow profuse. Oftenbetween periods would lose blood for a couple ofdays at a t ime. Sometimes slight watery dischargefrom vagina severe backache. Sexual intercoursepainful

,and followed by a d ischarge of blood from

the parts . Has lost twenty-five pounds in we ightduring this time ; has a poor appetite. and for thepast three months has been in dest itute circumstances

,and consequently unable to obtain suffi ci

en t suitable nourishment.Patien t evidently much emaciated, with that

pecul iar anxious, cachectic expression which iad icates a painful constitutional disease.P/zy sical Examination — A dark, grumous, fetid

fluid is found exudingfrom“

the vagina . Cervixuteri in normal position, but ragged and unevenaround external 05 . F inger could be crowded

‘

upcervical canalfor one-half inch. Tissue slightlygri tty to the feel , and easily broken down, bleedingfreely. The sound passed easfly through the

i nternal 05 after entering the canal above the d iseased portion for three and a half inches. Placin

g

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120

In mal ignant tumors i t was an important principleto err on the safe s ide, and remove as much of thesurround ing tissues as possible, so as to lessen thechances ofrecurrence — N. Y.fli ed . Journal .

attention gems and filters.

GROUND mustard rubbed on the hands w i l lremove the odor ofvalerian

,musk

,cod-l iver oi l

,

carbol ic acid, etc.

DR . MATTHEWS DUNCAN — It is now,we under

stand,defin itely settled that Dr. Matthews Duncan

will leave Edinburgh and settle in London,hav ing

been elecled to the offi ce ofObstetric Physic ianat St. Bartholomew

’s Hospi tal, on the resignat ionofDr. Greenhalgh . There is in all circles inEd inburgh a general feeling ofregret at losing on ewho has so long held a leading position in themedical profession there, and whose advice on

matters ofpublic business was much sought andhigh ly ~valued. as being that of a clear-headed,thoroughgoing

,and independent man . By the

Med ical S chool the loss w il l be particularly felt ,as he is recognised on all hands as being one ofthe most able and successful ofteachers. It i sthe i ntention , we are informed , ofhis med icalbrethren and others to enterta in Dr. Duncan at abanquet before he leaves. His resignation willthrow open the offi ces ofthe Physic ian forDiseases ofWomen at the R oyal Infirmary, andthat of Ord inary Physician to the R oyal MaternityHospital

,for each ofwhich appointments more

than one cand idate is already in the field — B r i t .

Merl. j ournal .

ON EMPYEMA.— In th e last volume ofGuy’s

Hospz'

tal R epor ts, Dr. Good hart d iscusses the question ofoperative procedurefor empyema. Al

though recogn iz ing that there are a few caseswh ich may be safely let "alone, he gives in his adhesion to operation by a single free open ing, withanti septic measures

,and with a large d rainage-tube,

as being the most effectual means of cure . Heinsists upon the necessi ty of making the openingas low as poss ible , fixing the point at the ninth intercostal space, opposite to the angle ofthe rib,the seventh space in the axil la , or the eighth between the axilla and the rib-angle. Further backthere is risk ofwounding the lung compressedagainst the sp ine

,and below these po ints the peri

toneal cavity may be entered. A large number ofcases are given

,w ith ful l details — M erlwo l and

S urgi cal R ep orter .

OPERATION SFOR PHIMOS I S DUR ING THE PR ES ENC E OFA C HANC R Es -i-Dr. Eustach Anton iew icz(Wiener M erl. P rcssc) ci tes the v iews of a largen umber of authori t ies who adv ise against an Operat ion for ph imosis (otherwise ind icated) during thecont inuance ofa specific ulcer ; most ofthem fear

THE CANADA LANCET.

closure of the wounds in these cases was th irteendays

,wh ile in a number of others

,not so treated

,

the ulcer las ted twenty-four days. He recommendsthe plan

,therefore

,because i t has tens the cure

, and

the wound i s not attacked by the ulcerat ive process — S ci: No. 7 , 187 7 . C l in ic

NEW METHOD OFTRAC HEOTOMY SPEC IALLYAPPLIC ABLE IN YOUNG CHILDREN.

— l) r. J. J . R eid ,ofNew York , advises the following method ofoperating -After the usual incis ion of the skin

,

and the division ofth e strong superficial fasciawhich connects the sterno-hyoid muscles , the knifeis laid aside, and the next part of the operationperformed by two uterine tenacula. With thesethe deep laye rs offascia are torn

,and the thyroid

veins are pulled aside until the trachea is sufficien tly exposed. The tenacula are then insertedinto the sides of the trachea , and sl ight traction ism dc, while the tube is laid open to the des iredjexten t W i th a bistoury. The wound in the trachea isthus made to gape widely, and any piece of membrane can be removed and the tracheotomy tubeeasily introduced. The advantages claimed for thismethod of operating are that i t reduces to a minimum the risk ofhaemorrhage, serves to fix thetrachea withou t the danger ofcompression of thetrachea and larynx , andfacil itates the introductionofthe tube.— T/ze D octor .

CE SAREAN SEC TION AFTER DEATH '

— DELIVERYOFA L IV ING CHILD — Dr. Buckell, of Winchester,reported to the Obstetrical Society (Med ical Timesand Gaz ette) the notes of, and showed the visceraof a case in which Caesarean sect ion was performedtwenty to thirty minutes .after death . The childwas saved. The mother died suddenly ofd ilatationofthe aorta

,rendering the aortic valves incom pe

tent. At the post-mortem exam ination the v isceraeof the chest and abdomen were found to be transposed. The president thought the case ofinterest

,

as showing that a ch i ld could be recovered a con

s iderable time after the death ofthe mother. Dr.,

Aveling said that i t is believed that a ch i ld may beborn alive an hour after the mother ’s death . Dr.Playfair said he knew of one case in wh ich a l ive '

child was born half an hour after the d eath of themother. Dr. R outh said that much d epended on

the cause of the mother ’s death . He had performed Caesarean section in a case from apoplexy

,

‘

bu t the child was dead from carboniz ed blood.

Dr. Daly saw C a sarean section done twenty minutes after rupture ofthe u terus, but the child wasdead.

-Amer . y our . M erl. S ciences .

THE CANADA LANCET.

THE PENGE CASE .

is case which has lately been a subject ofsuchinteres t to th e Medical Profession in Engand which has iust been terminated by th e

One ofofth e

others to imprisonment for l ife . has. we think several

important l essonsfor us in Canada which shouldno t be overlooked . The d ecision arrived at by.

Mr. Cross imp l ies no doubt ofthe guil ty inten tionof the prisoners, bu t i s a resul t ofa memo rial

signed by seven hundred and th irty‘

three medical

men exp ressing th eir op in ion that th e post mortem

appearances of th e body ofHarriet Staun ton werenot such as to j us tify the conclusion that death wascaused by starvat ion , or any other form ofmurder.”

We do not propose to go in to the case i tsel f,wi th which our readers are no doubtfamil iar

,but

to call attention to those p oin ts wh ich affect u s asmed ical wi tnesses in a Court ofJustice , and aspathologists . The first poin t that concerns us

,i s

the increased difficulty there wil l be hereafter inproving death by starvation. This case

,remark

ablefor th e u tter failure ofth e medical evidenceto prove What was requiredfrom i t, will be a stand

al l future

d ical wit

e, will not have to rest

he resul ts ofin sufficien tbody were present ; he

in a posit ion to affi rmconsequent on inabil ity

to assimilate food, i f i tther words, he will be

121

absence Of any disease that would neutral iz e th ebenefi t of food taken and digested , before h e can

say that the patient died from being deprived Of i t.And in giving such evidence

,he must be un influ

enced by anyth ing beyond what can be deduced

from a careful and thorough examination ofth epatien t during l ife and after death . We are all

conscious of how ready we are to be influenced byth e surroundings of a case in forming an opin ion ;of how ready we are to j ump to a conclusion

soon as we have observed one fact on which to

found i t,and to cease looking further. This ten

deney has been painfully exh ibited in the unfortunate case to wh ich we refer, and we also see how

easily i t may lead to a failure ofj ustice.The second poin t about which we wi sh to say a

few words,i s regarding the care required in making

post mortem s , and th e competency ofthose makingthem . One unfortunate resul t ofth e l imitedopportun itiesfor anatomical research in th is country is

,that i t is almost impossibl e for th e s tuden t

to become suffi cien tly familiar with the appearancesofdiseased tissues to be abl e to recogniz e them as .h e ough t . After en tering in to practice, h is oppor

tum tres in the majority ofcases ofseeing or makingpost mortem s , are practically n il and a great part

ofwhat h e had l earned , is forgotten , when perhapssome case occurs suddenly requ i r i ng large anatom

ical and pathological experience to enabl e h im to

give a correct Opin ion,the lack ofwhich may l ead

to th e escape of the guil ty or th e conviction ofth einnocent. This deficiency i s fel t in England where

the opportun ities for pathological research are far

in advance of those here. The evi l consequentlyexists to a still greater exten t among ourselves, and

leads to a great deal ofthat d ifference ofopinionwkich i s the reproach of th e medical profession .

Want ofcare in making th e post mortem sometimes occurs

,and though it is to be hoped this is

rare,yet cases with in our own knowledge have

shown that i t does take place. One instance ofth is happened not many years ago. in a case in

which a man was tri ed and convicted ofpoisoninghis wife . The medical man who made the post mor

tem neglected to tie the stomach before removing

it,and so allowed the contents to escape into th e

abdominal cavityfrom which he removed them

by scooping up what he could with his hands.

The jar containing the viscera also remained un

sealed for several d ays before i t reached the

122 THE CANADA LANCET.

analyst’s hands. Such omissionmigh t easily renderthe ev idence ofboth medical man and analystworthless , and would not have occurred had theoperator been more mefall at h is work.

The failure ofthe medical evidence in the PengeCase has l ed to a renewedfeeling amongst theprofession in England that the most effectualremedy for such occurrences in th e future wouldbe

the appointmen t ofmen notedfor their experienceand ability in observing post mortem appearances

,

whose duty i t should be to conduct post mortems

i n criminal cases ; men whose familiar ity with the

subj ect would render them less l iabl e to err in

interpreting what they saw, or to overlook any

condition that might have in any way influenced

the death Of the person . In England , i t i s prob

able that persons so appointed would have their

t ime so fully occupied that they would be able to

devote their whol e atten tion to th e work. In

Canada i t would not be so,and the diffi culty of

finding su itable men for such a posit ion would be

great,as there are sofew here who are able to

dispense with practice and cultivate a specialty of

this kind. We bel ieve,however

,that a great im

provement on the presen t mode ofconducting postmortems in cases the subject ofl egal inqu iry,m ight be made if the Government were to bring in

an Act empowering the Minister ofJustice toappoin t certain men in the larger cities

,who might

be called by the coroner to aid the local medical

man in conducting the post mortem in al l casés ofdeath under suspicious circumstances ; such men

to be entitled to receivefees and travell ing expenses at a fixed rate in al l cases in which they

might be called on to act. I t would not be d itficul t to find men in Toronto or Montreal connected

with the Hospi tals whose opportunities there, aresufii cien tly great to render their opinion of weight,and the experience they would gain would go far

in time to remove the doubt and uncertainty so

frequently attendant on medical evidence in criminal cases. The experimen t would, we th ink , at

any rate be worth trying,and in the long run would

not probably increase the cost ofthe administration ofj ustice, while i t would probably improve itseffi ciency.

VIBURNUM PR U NIEOLIU M.— Flu id extract of

Viburnum prunifol ium is being used with gratifyingsuccess in cases ofthreatened abort ion , uterinedebil ity

,irri tab il i ty and hemorrhagia, by the profession i n the United States and Canada.

ENQUI R Y INTO R ECENT DOUBTSTHE VALUE OFVACCINATION .

I t has been considered by a few physicianscent years that vaccination is not only useles

physiology,nor any philosophical basis and

there is no instance in wh ich the inoculati

one disease preven ts another. They also

that the general mortality has not been diminby vaccination that the argument that vaccin

,br op tsr fioc,

l

and overlooks oth er concurrent cir

cum stances that smal l pox is not the horrible anddangerous disease i t once was, i ts treatment beingmuch better understood —also that if it does standas a preventive ofsmall-pox, the chances arem ill ions to one, that i t imports other and more

powerful disorders in to the system . That as cow

pox i s generated

in dirty stables so smal l pox prevail s among the

di rty,low

,i ll fed

,unwashed population . That as

the plague,j ail-fever, leprosy, elephantiasis, sweat

ing sickness,and black death have passed away with

advancing civilization , so has the cow pox OfjJenner .

Further, that cleanliness is the great prophylacticagainst epidemics

,small pox included . Civil ization

has ban ished many epidemic diseases, and ought

to have got rid ofsmal l pox: I t i s al so statedthat the excessive mortal ity of recent epidemics is

to be attributed to confinement in smal l pox

hospital s which necessarily occasions a great in

crease ofmortal ity by the congregation ofa numberofcases in a limited area —and that cow pox

'

weakens th e power ofvital ity and imparts or callsin to action diseases which would otherwise remain

dormant,as syphil is

,scrofula, skin d iseases , etc. ’

To meet these numerous obj ections we cannotdo better than furnish Our readers with afreely ordigest of the evidence taken before a committee ofth e English House ofCommons (see Blue Book).Mr. Simon ,F.R .S . has formed his opinions on

“

vaccination as a preventive ofsmal l pox, not onexperience as a practical medical man , but as a

medical statistician by considering masses ofnational evidence

,and as a reader

'

ofmed icalhistory. He considers small pox in the absence

ofvaccination the most fatal pestilence.It i s not a declin ing disease ; small pox com~ l

tagion being always present, an unprotected

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124 THE CANADA LAN0ET.

Wm . James,Dr. Gull

,2 5 years physician to Guys

Hospital ; Dr. West, physician ofthe Children ’sHospital ; Mr. Hutchinson , surgeon to the Lon

Ophthalmic and skin diseases hospitals Dr. Seaton ,Medical Inspector Privy Council , corroborates the

views ofMr. Simon ofthe protection afforded byvaccination agains t smal l pox. Their evidence

will also be found in'

the same book .

CONFER ENCE WITH THE AMER ICAN

MEDICAL ASSOCIATION .

At the meeting of the Canada Medical Associa

t ion held at Niagara Falls in 1 8 74 i t was resolved

that. in consideration of the true interests ofMedical Science , i t i s desirable that a medical con

ference should take place between the American

and Canada Medical Associations at some central

point to be determined upon ; and that the Ameri

can Association be advised as to th e desirabil ity ofthus becom ing more in timately acquainted

,and af

fording an Opportun ity for th e discussion ofmedicaland surgical ques t ions on a common basis.”

At the meeting ofthe American “ Medical As

sociation in Lou isvil le,in 1 8 7 5 , this idea was recip

procated , the subj ect was taken up, and it was

resolved “ that a comm ittee of th irteen be appoint

ed, whose duty it shall be to confer with a i ike

committee ofth e Canada Medical Association atsuch t ime and place as may be agreed upon by the

joint committee ofth e associations.” The meeting

ofth e joint committee took place in Philadelphia,

in September,1 876 , and i t was unanimously resolved

that in th e opin ion of th is conference the interests

ofmedical science wil l be promoted by a consol idat ion ofthe Canadian andAmerican Medical Associations in one body

,

” and “ that the president of each

association respectively be requested to embody

this idea in his annual address in order that the

matter migh t be taken up and more fully discussedat the next annual meeting.

”

Dr . Bowditch , President ofthe AmericanMedical Association , at the annual meeting in Junelast, took up the subj ect in h is address and placed

the arguments pr o and con . before the association.

In favor ofthe plan h e mentioned the followingreasonsFi rst, We should associate ourselves with a bodyofphysicians, all ofwhom have been educated

under Engl ish influences, and In

pursued their stud ies in Englanddiplomas from the schools ofthat country.

al l know the h igh standard ofqualificationquired by the Brit ish schools.

S econd, Why may we not look upon such a

nection ,as quite similar to that wh ich has

quently taken place and which w iwhen a

‘

new State in th is Union is formed?In that case, if a State med ical society

gan iz ed , i t has a right to send delegates to t

sociation . The only differen ce,i n the two

would be that Canada embraces a very much larger

constituency than any ofour newS tates would have.Thi rd , I am inclined to look with fa

‘vor upon

the proposed un ion from the standpoint of civiliza

t ion itself. There can be no doubt,as already

stated, that th is American Association has been agreat means for promoting

different sectionposed Union iwimuch

naflon

get only good from such co-operation .

that we can bring to unite mankind

delight.Fourflz, I will allude to what would giveI doubt not, many more, great pleasure.th e united professions to meet in the OldMontreal and Quebec

,and pass up and d

noble St.

l ength , depth ,more fascinati

European civil

al l stand on t

and I think,

learn a divine lesson ofmwe could together look at

the graceful action of the British Government, to

the j oint memories of Wo

brave soldiers, antagonists

j oint heirs in the memories

The object

were chieflythe American

much too larg

the expenses ;

THE CANADA LANG ET. 125

served to mee t

He said : The Canada Medical

did not ask for amalgamation,or to

absorbed by the American Medical

but merely for a conference at some

so as to become “ more int imately

and to discu ss medical and surgical

a common basis."

asked for

and in resrlving that

“a un ion of the two associations into

me i s desirable ,” they expressed their own views

,

ced and liberal,no doubt

,—but Spoke not

Canada Medical Association,which

,at

in 1 8 74, asked merely for a“ medical

ce,for the “ discussion of medical and

questions on a common bas is without

los ing, or wish ing to lose, i ts

said that un ion for sc ientific purposes

possible, bu t that all matters pertain ing

1 ethics or education could not possibly

discussed or settled by two peoples so

other in many th ings,so far asunder in

We fully endorse the sen timents ex

d trust that the two

career ofusefulnessi ts own sph ere, and that the

d mutual good-will may always

The system ofsending deother associatio n cannot

,at

to come, be improved upon .

Dr.full

HERO I C CONDUC T R EWARDED.— A pleasing in

ciden t at the meeting ofth e Bri tish Medi cal Association , was the presentation of medals to several

TURKISH ARMY MED I C AL SERV IC E — The Turkish Army Medical Serv ice i s said to be in a most

deplorable condi tion . I t is totally i nadequate in

numbers and qual ity, and the condition of the

s ick and wounded is most dis tressing. The sup

pl ies are scanty,a nd th e unfortunate wounded

are days without any relief,surgi cal assistance

,or

even food. After a battle near the Shipka pass

in which were wounded , there were only four

surgeons to look after them . The English and

foreign surgeons who have gone to the seat ofwarhave not been very cordial ly rece ived , and in some

instances were forbidden to perform operations

n ecessary to save the lives ofth e soldiers . The

Turkish medical offi cers at Erz eroum refused to allow amputation to be performed, because

“ i t was

better the men shou ld die than become a burden onth e Sultan .

” In s tead ofthe inhuman Turks beingthankful of assistance, the English aid societies

have actually to compel them to receive helpfor:their sick and wounded.

NO EXC US EFOR ANY ONE BE ING O U T OFEMPLovMENT.

— Our atten t ion has been cal led to somenew and useful household inventions recentlypatented by L. E. Brown C O .

, ofCincinnati,

Ohio,wh ich make housekeeping a pleasure, instead

ofa dreaded necess ity. They have been having

avery large sale for them throughout the United

States,and now wish to introduce them through

the Dominion ofCanada, and offer good reliablelady or gentlemen canvassers an opportuni ty seldom

met with for making money rapidly.For termsand territory write at once to L. E. Brown C O . ,

2 14 and 2 1 6 Elm Street, Cincinnati, Ohio.

IMPROPER R EGISTRATION .— Dr.F. D . Gilbert

,

OfSherbrooke,Que. has brought a charge again st

Dr. G. E. Fenwick , ofMontreal, and Dr. E. D .

Worth ington , ofSherbrooke, of Issu ing a false certificate ofregi stration to a physician , to enablethem to secure the .prq rofth e latter at the electionofthe board at Three R ivers, Quebec. The case

is now before the courts for investigation , and werefrain from any comments at present

,

wehope

for the credit ofthe profession i n Quebec that thewhole matter may be satis factorily explained.

126 THE CANADA LANCET.

med ical men ,for their heroism in assist ing in therescue ofminers in the coll iery acciden t In Aprillast at Point-y-Pridd . The doctors were unremi t Macdougall and Hon . M ' C ’

Navy, and Volun teers,” byt i ng m then attent i on , and by the i r presence cheern edy ; the

“Univers it ies wited and encouraged the miners to persevere in their ted , by the Hon. Justiceattempt at rescue. Drs. Dukes and David were the Un iversity S

.B

.Harman

,fi rs t, who, after communication had been establish vers ity 3 and Mr. Hendersoed, crep t through the narrow channel at the peril T

i

r

a

iiiiii

yt i

Medil

ézlt

giht

gol,fit:

ofthe i r l i ves. S i lver medals were awarded to each, H0dder, Bethune, Ge ikie, anand the gold medal to Dr. Dav i es

,the coll i ery

surgeon , who superin ten'

ded the efl’

orts ofthemen, remaining whole days and nights in the pit.Bronz e medals were awarded to several o thers whorendered essential service.

THE JEFFERS ON MED I CAL COLLEGE HOSP ITAL.— The new hospital of the J efferson Medical C oll ege has recently been Openedfor the reception ofpatients. I t is built ofbrick with Oh io stone facings, five stories high , and consists of two wings inthe shape ofthe le tter L. Within the angle i s a

two-story amphitheatre capable ofseating 600 students. The bu ilding is heated by steam ,

and fresh

air is obtained by Openings beneath the w indowsand behind the steam heating C oi ls ; also by ducts

open ing from the street into the basement,where

i t i s heated and passes into the various parts ofthebuilding through fines and registers. The 0p

portun ity for clinical instruction here will be very

good, and cl in ics wil l be held throughout the winterand summer sessions.

TR IN ITY MED ICAL SC HOOL — ANNUAL D INNER.

The annual dinner ofthe Faculty ‘and Students ofTrinity Medical School, was held in the Queen

’s

Hotel on the 2 l S t ultimo. The chair was occu

pied by Mr. Charles Sheard, and the vice-chairs byMessrs. W. H . Doupe and B. Spencer. Among

those present as invited guests were Mr. Justice

M orrison, Senator Campbell, Hon. William Mac

dougall,Hon . M . C. Cameron, His Worship the

Mayor,Alderman Boswell

, R ev. Dr. Topp, Mr. S.B. Harman, Mr. W. S. Lee, Mr. Thomas McC ros

son , Mr. VanKoughnet, Drs. Workman, Clark,P n e O

’

R ei ll Barri ck, Canniff, Moo’

rehouse,Myore

’

,Stuart, Teskey, W. W. Geik i e, and others.

TR IM?! COLLEGE ann ua

The band ofthe Tenth R oyals was s tationed in convocati on ofthe U a C rS l ty ofTri n i ty Collegithe gallery, and during the evening rendered some was held on the I sth ult., in thefine select i ons in good s tyle. Letters ofregret Hall. The following gentlemwere received from several invited guests who were degree ofM .D.

— W. W. Geikie,unable to be present. After dinner the usual loyal G. Stark .

and patriotic toasts were proposed and duly hon Matriculants in Medicine. —E.

fess ions,” “The Graduates and Class oftheent Session,

“The Ladies,

” and “The Press,

”

which were interspersed with singing by th

dents, the company broke up after m id

having enjoyed a very pleasant evening’stainment. — [C OM.

ANNUAL DINNER '

OE THE TORONTO SC HOOL 0MED IC INE. — The annual dinner ofthe ToronbSchool ofMedicine was held at the R oss in Honson th e 9th ul t. In addition to the faculty ofthschool and students the following gentlemen wer i

present : Mayor Morrison,Drs. Workman , Clark

O’

R ielly, R iddell, Fraser, Langstaff, Griffin, Mc

Phedrain, Winstanley, Pyne, Bascom, Cameron

Schmidt,White

,and B lack. Upon the remova

of the cloth,letters ofapology were readfrom sev

eral invited guests,after which the usual loyal an t

patriotic toasts were proposed and responded to

Several humorous songs enl ivebetween the speeches. Thevery pleasantly by al l present.

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128

ofan ordinary wal let, and can be carried in thepocket without any inconvenience. I t contain s

many useful tables,formulae and doses ofmedi

c ines and new remedies,direct ion sfor exam ining

the u rine,making post-mortem s

,etc. This visit

ing l ist is well got up , and cannot be too highly recommended. Dr. Walsh also publishes a HANDYLEDGER

,a companion to the Call book and Tab~

let, price Both ofthe above may be hadby addressing Dr. Walsh , 3 26 C . S t., Washington .

PHYS IC IAN ’S VI S ITING LI ST, by Wm .

A.M .,M .D.

I . 25 .

The advantages wh ich are claimed for this work

e, that being ru l ed for a month instead ofa week,the names of patients are written but once in themonth, and that on this account, i t i s also moreconvenientfor posting.

O ldright,

Toronto : Wm. Warwick,price

N INETEENTH ANNUAL R EPORT OFTHE HOS P ITAFOR IN SANE, Nova Sco t ia, for 1 87 6 . Dr. J. R

Dewolf, L. R . C . S . E.,Medical Superintend ent,

D . A. Fraser,M .D .

,Assistant Phys i c ian .

I t is evident from a careful perusal of the report

before us,that th is insti tution is do ing a good work .

On the firs t of January, I876, there were 3 18 pa

t ien ts in the hosp i tal.TRAN SAC TIONS OFTHE CANADA MED I CAL AssoC IATION.

This work which has just been issued from thepress forms an octavo volume of240 pages, w ithseven fu ll s iz ed plates, an d contains the proceedings

,President’s address

,reports ofcommittees,

and eight Medical and six Surgical papers. The

price is Subscript ions and orders shouldbe

l

sen t to Dr. Osler, 1 35 1 St. Catherine Street,Montreal

,Secretary Publicat ion Comm ittee.

THE PHYS IC IAN ’S SELF-COPYING PRES C R I PTIONBOOK AND BLANKs ; by W. A. Anderson , Lacrosse

,Wisconsin. Ch i cago : Hadley Bros . 6:

Co. Price 35cts .

,

each.

The above is a blank prescription book, arranged with carbon paper which enables the practi

t ioner to write h is prescription in duplicate with anordinary lead pencil

,one copy ofwh ich i s reta ined

and the other sent to the druggist. There i s alsoa space on the retained prescript ion for rec'ord ingthe pulse

,temperature

,resp i rati ons, &c. Th is

pocket compan ion will be invaluable to those who lare i n the habi t ofkeep ing Copies oftheir prescript ions

,and every one should do so.

THE CANADA LANCET.

U NlTED S TATES ; byS econd ed ition

,revised

delph ia : Med. and Surg

HOW TO U S E THE OPHTHALMOS C OPE, by E.

Browne,M . D. ,

Liverpool : Ph i lade lphIa, H .

Lea. Toronto : Wi ll ing 61 Wi ll iamson .

At Woodbridge,on the 2sth Oct. , the wife

Dr. Grant,ofa son .

At Mount Pleasant, on the 3oth October, twife ofDr. Marqu is of a son .

At Woodbridge, on the roth ult. , the wife ofJ .

Wi lkinson , M . D.,of a daughter.

In O ttawa, on the 9th ult. , Dr. Germain of

typhoid fever.OBITUARY.

—The death ofPaul F. Eve, M . D.,

Nashville,Tenn.

,aged 7 1 years, the d is t i rigu ished

American surgeon i s announced. Als o Dr. Martyn Paine

, New Yo rk , the d i st ingu ished med icalsavant, aged 82 years.

T11: c/zafgefor n ot i ce ofB ir th} , Ma r / iages and Dea l/Es ,rs fif/y ce nts , w/zz

'

o/z s/zou ld beforwarded mo

postage stamp s ,tad /z the comma ) .i al zon .

This is a very large and important w

ing as i t does the names and addresses ofphysicians in the United States. All the i

acies and om issions ofthe firs t ed i tion soknown have been corrected. Besides theof physicians

,the work contains a fund Of v

information regard ing medicalp i tals , societies, heal th resorts , m ineral spr

&C ., &c. I t will befound a most convenient a

useful work ofreference at all times.

0At Carleton Place

,on the 1 5 th ult ., R . W. Bell ,

M . D.,C. M .

,ofPeterborough, to Nel lie , youges t

daughter of John Sumner, Esq. , O ttawa .

At Millbrook,on the 1 4th u lt.

, J ohn Hunter,M. D.

,to Liz z ie

,eldest daughter of John R enWIck,

Oro no .0

In Toronto on the 14th ult. , John A . Stevenson ,Esq.

,M . D.

,of London

,Ont. , to Annie I sabel,

eldest daughter ofthe Hon. W i n . Proudfoot, ViceChancellor ofOntar i o.At Brockville

,on the 14th u lt. , Archi bald Mal

loch,M. D. , ofHam i l ton, to ' Francis Mary,

daugh ter ofthe late Dr. R eynolds.

THE CANADA LANCET.

ANADAA MONTHLY JOURNAL OF

ANCET,

AL AND SUR GICAL SCIENCE .

F LEAD , IN LAR GE DOSES , INPOST-PAR TUM AND OTHER HXEMO R R

HAGES .*

BY J . WORKMAN , M .D.,TORONTO .

I t is now nearly fifty years since a d iscovery wasth e late Dr. John Stephen

regarded by h im,and

,

very j ustly,as a very important thera

About the year 1 830 Dr. S tephenson

ted by a man who was troubled with a

varicocele . With but meagre expectat ion ofdoingh is patient any good

,he gave h im a dose ofepsom

salts as a purgat ive,and two drachms of the acetate

of lead to be used as a lotion on t he scrotum . He

did not again see th e man for some weeks. Meet

ing h im one day on the stree t he enquired how he

had got on . The man repl ied he was cured . Dr.

Stephenson was rather sceptical as to thi s favour

able issue,and questioned him as to the efi‘ects of

the two drugs . He repl ied that he used the large

powder as a lotion,and disolved and swal lowed the

o ther. I t was very sweet, he said , but it purged

h im well. Dr. S tephenson afterwards examined

the scrotum,and found that the varicocele had

really disappeared. He was a man ofsharp percepti on and rapid conclusion . He had twice nearly

rtum haemorrhage , though

means then in favour. He

next confinement, Should

of a large dose ofth ehad set in . He gave

p ty ing ofthe u terusthe organ contracted

took place. I n

same precaut ion,and i t was fol lowed by a l ike re

S ti l t . Throughout his obstetric pract ice,which was

pretty large,he treated every severe case of pos t

partum haemorrhage w ith the acetate, general ly i ndrachm doses

,repeated if deemed necessary. No t

i n any in stance d id the sl igh test evi l follow.

S hortly after his first test of i ts anti-haemorrhagic

QC i lO ‘ l, a servan t man of the late Professor Holmes

was seized with a formidable haemoptysis . He was

placed in th e Montreal General Hospital . The

haemorrhage res isted all the remedies prescribed bythe attending physician .

“ A consul tation of th e

Hospital Staffwas called . Dr. Stephenson related

his experience ofth e efficacy ofth e acetate, andproposed i t in th is emergency, but none ofh is colleagues would venture on his large doses , for they

had all been taught,and as in duty hound they all

believed,that i t was an irritant poison . The patient ,

however,was bleeding to death , and they yielded ,

but at the same time told Dr. Stephenson he mus t

take the entire responsibil ity on himself, wh ich hmost readily and fearlessly did . I do not remem

ber th e total quantity of the acetate wh ich was given

to this patien t, but I know i t was large, several

drachm s in the course ofa few hours . The man ’s

l ife was saved . Som e. years after I saw him in Dr.

Stephenson ’s offi ce. The Doctor sounded his chest,

and showed us that one l ung was sealed up.

Dr. Stephenson, in his midwifery lectures, stren

uously inculcated th e theory ofthe anti-haemorrhagic action ofthe acetate , and i ts perfect harmlessness in large doses. I have been a faithful di s

ciple , both in my general practice , and as a teacher

of obstetrics, and I am aware that a number of my

fellow s tudents,and nearly all my pupils

,have re

alized the same valuable resul ts as Dr. Stephenson

and myself. I could corroborate thi s statement by

many witnesses, some ofwhom now hear me. I

th ink I may safely appeal to one of my fel low stu

dents,whose testimony will command the warm

respect ofthis en tire Association , n eed I say thatthat I mean our venerable and most sincerely

esteemed Secretary ? Alas ! he is, I bel ieve, al l

that now remains to me,in th is city

,of my contem

poraries ; you w il l n o t, therefore, wonder that Ib oth esteem and love h im .

I never but once saw th e sl igh test sign of thelady he took the evil consti tutional results ofthe acetate

,and that

on e exception occurred in a case of haemoptysis , i n

w i i ich my con su ing fri e nd would not consent to

130 THE C ANADA LANCET.

exceed five grain doses, and these he insisted on

guarding by one grain of Op ium with each dose .As the case was his, and I could not dissipate h isfears, I did not feel called on to contend againsthis scrupl es. I II due course the pecul iar lead gum

put in an appearance . The acetate ofl ead given ini ts pure state, in large doses, not only requires no

op ium as a protective against i ts a ction,but it is

my conviction it i s always unwise to aim at anys uch protection and in this relation I would alsoinculcate the inadvisab ility ofthe addition of aceticacid . I pretend not to go into the chemical merits

ofthe question , but it is my impress ion that thisaddition of acetic acid is more l ikely to favour nu

des irable chemical. tran sformation than to preven ti t.

'

I am , however, quite sure that no .such pre

caution is necessary. I always took care to use apure sample, free from any portion ofthe carbonate 3 but even should some portion ofthe latterbe present, as it i s insoluble in water, i t soon falls

to the bottom ofthe solution , and then we are perfectly safe in giving the clear fluid .

I remember one case of very profuse lung haem

orrhage in which I adminis tered within twelve

hours six drachms. The man was saved,and h e

lived several years after, but finally died ofpulmoinary phth isis. I gave eight drachms in the course

ofsixty hours to an asylum patien t. In neither ofth ese cases did any lead symptoms

,nor, indeed,

any other unpleasant resul t follow. My asylum

patien t survived her haemorrhage three years,and

died ofph th isis al so.

I was rather surprised, if not a trifle mortified ,

to find that,in a total of perhaps one hundred and

forty students ofth e two Toronto med ical schoolsexam ined by me on obstetrics las t April

,only one

gave,amongst th e multifarious suppressors ofpost

partum haemorrhage, th e exh ibition oflarge dosesofthe acetate oflead, whils t doz ens named it inpaltry doses

,guarded by acetic acid or opium . At

Kingston,however, where midwifery i s taugh t by

my old friend and pupi l , Dr. Lavell , I found a veryd ifferent state ofmatters, and I fel t I was not yetutterly ignored .

Not long ago a very clever med icalfrlend , whendiscussing with me the merits of the acetate inpost-partum haemorrhage, exultingly asserted thatbefore i t could come into action the woman wouldbe dead. My reply was, I am convinced you

have never tried i t in large doses and neither had

I have often been asMore especially have Ibeen speedily vomited . The uterus has a

to me to shrink down into normal globul

almost instantly. I do not bel ieve we hav

our materia medica, a more prompt, orpot

moter ofuterine muscular contraction .

Why,in the nameof Heaven , we

a poor sh ivering woman with pail fuls

or inj ect into the uterus such irritants

Ofchloride of iron , when we have atharmless and effi cient a suppressor oas the acetate ofl ead

,is qu ite beyond

prehension .

A few days ago,i n a conversation with m

spected asylum successor,Dr. Daniel C

President ofthe College ofPhysicians andgeons ofOntario, I requested him to state hiper ience in the exhibition ofthe acetate inpost-partum haemorrhage, and to inform me

doses

usual

beenseen any collateral resul t moreremarkable than

vomiting,in exceptional

.

ins tances ; but an invar i

able coincidence ofth is symptom was the completecontraction of the u terus .Dr. C . has been even more heroic in h is doses

than Dr. Stephenson or myself. I more generally

gave half a drachm than a whole one, repeatingth is when deemed necessary. Another ofmy o ldpupils some years ago informed me that his dose

was two drachms.

I believe it will generally be found that in these

large doses i t acts as a moderate purgative with intwenty-four hours and

,if it be desirable that , in

order to avert transformation ,i t should be ex

pelled from the bowels in th is way, i t may be better

to err on the safer s ide,which certainly is not its

exh ibi tion in small doses.I trust

,gentlemen

, you wil l not for a moment

suppose that I inculcate the employment ofth ismedicine in every case

,however trivial, ofuterine

haemorrhage,though I am fi rmly convinced ofi ts

harmlessness . You al l understand too well theefficient mechanical means of inciting uterine contraction to imagine that where these are adequateto our purpose

,I would employ uncal led for

supplementary means .

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THE CANADA LANCET.

d uring the above mentioned operat ions,and al so

from d issection ofa ranula in the dead subj ect,

he is convinced that it i s more frequen tly found to

have some other seat oforigin . Al l the cases investigated by the author were entirely unconnec tedw i th the sal ivary ducts . The tumor in each casehad evidently originated in the areolar tissue

around the fraenum l inguae . The microscopical

examination ofthe con tents ofthe cyst in thesecases revealed globular and tessellated epithelium

,

with crystals of cholesterine,and in no instance was

there to be found a reaction resembl ing that pro

duced by sal iva. The author recommends ex

c ision of the ranula as the proper treatment,and

preferable to injection of iodine, or incision and

cauteriz ation combined, being more speedy andattended with more permanent resul ts. Two

methods are adopted in one the tumor is freely

incised and the walls ofthe cyst dissected awayin the other the cyst is wholly removed at once

together with its. contents. If the wal l ofthe cysti s very th ick

,th e latter method is to be preferred.

MULTIPLE PER INEAL CALC UL I .— The followingin teresting case reported by Dr. R oja in the Annalz

’

Ufzz'ver salz' dz“ Med. C /zz'

rurg . A young man,aged

eigh teen years,had required occasional catheterism

ever since childhood on account ofretention ourine

,but after each operation he remainedfor a

considerable time free from arouble. On examination the Dr. found a large perineal tumor the

s iz e ofthe fist, and on introducing a catheter,i t

came in contact wi th a calculus in that situat ion .

The patien t was put under chloroform,and an i nc is

ion made in the perineum through which about one

hundred calcul i were removed, some ofthem as

large as a fi lbert, one of wh ich only causing the‘

obstruction . The stones were facetted and ofprostatic origin cons isting of magnesium carbonate ,urates

,and ammonia-magnesium phosphate. The

Dr. incised the prostate through the wound and. explored the bladder with his finger to make sure

that none remained in that organ. The case p ro

gressed favorably and a perfect cure resulted.

QUIN INE IN Ep ISTAX Is.— A writer in the Lon

d on Lancet says qu in ine is tire remedy in ep istaxis .'

H e says that he has tr ied it more than twentyt imes, often in aged people, and has never foundi t tofail.

d nrrtspnudmrc.

GR EAT WESTER N R AILWAY MEDICAL

TAR IFF.

To the Ed i tor ofthe C ANADA LANCET.

S IR,

-The Great Western R ailway Company hasadopted and offi cially promulgated a singular tariffofmedical fees for attendance on their employeesalong their various l ines . One might suppose thatsuch a company as this would allow a fair and

reasonable remuneration for profess ional servicesin Cases of

.accidents to their men . But what is

the fact ? That the mun ificent sum ofone

dollarfor the term ofone year,together with a free

ride over their l ine to and from the patient, is the

total amount offered ! A man may meet with aserious accident fifteen or twenty miles away, and

the surgeon is sen t for,i t may be to perform a

capital Operation and give all the subsequent attendance

,and this for the sum of one dollar . Can

th is be called a fair transaction ? What astonishmen t would sit on the manager’s countenance

were he required to serve the publ ic on a S imilarscale offees ? The strange th ing is

,that withfew

exceptions,th is tariffhas been accepted, and that

too without remonstrance or effort to repel the i i isul t offered to the profession by the medical menalong the l ine. They must be aware that i t isei ther an imposition on their generosity or an at

tempt to obtain their unrequited services on thevague and illusory hOpe that by this means they

may enlarge their more remunerat ive family prae

t ice. In ei ther case it is not legitimate business ,a nd will be found in the end to be as un satisfactory as i t is unj us t.The medical profession has in general been able

amicably to agree upon a scale of charges ofa fairk ind

,both to themselves and the publ ic. Why

may they not un i te to tel l th is powerful Corporation that i t cannot have their services on otherthan fair profess ional terms ? Surgeons m ight bewilling to concede something on the score ofhuman ity and to the claims wh ich accidental injuriesto work ing men may have on their benevolence ,bu t the concession should not all be on one s ide .

The company Should have equal cons ideration, ifnot more

,for men inj ured in i ts service, and be

will ing to securefor them on reasonable terms thebest surgical a id. Th i s is a question that demands

THE CANADA LANC ET.

the serious cons ideration ofth e medical professionofthis Province , if not also ofth e whp le Dominion .

Yours tru ly,D . L. P .

Brantford,Dec . 1 8

, 1 87 7 .

S tltrttd aman .

ARSENICAL POISONING TR EATED WITHDIALYZED IR ON .

A case of arsenical poi soning occurred lately inmy private practice

,wh ich seems to be valuable

enoughfor publ icat i on,both on account of the

completeness ofthe detai ls and the intell igenceand reliab i l i ty ofthe patient, but especially as i t is ,so far as I am aware

,th e first case where the new

remedy d ialyz ed iron has been pu t to thetest as an anti dote .As I was l eaving my offi ce on e morning, a few

weeks ago,a young lady patient, Miss S .

, hastilyentered

,with a face indicative of intense pain and

nervous disturbance,saying

,Doctor, I am poi

soned .

” Her story was as follows. While attending to the wants ofa valuable servan t who wassick and confined to her bed

,Miss S. found h id

den away in the servant’s trunk a paper ofarsen ious acid, which had been procured by Mrs. S.

some weeks before,for use as a poisonfor rats .

As this servant had been in il l health for sometime

,and morbid and melancholy, Miss S. at once

very naturally,and no doubt very righ tly, supposed

that she had secreted the poison for the purposeoftaking her own l ife. Quietly placing the packetofarsenic (which was open) in her pocket, shecontinued her duties

,in tend ing at the earl iest mo

ment to pu t i t in a safe place. Days elapsed, th earsen ic was forgotten

,stored away in th e pocket

ofher wrapper, until th is unlucky morning, when ,putting a couple ofhandfuls of gum-drops andbon-bons into her arsen ic pocket, she sat down to

her sewing-mach ine and her confectionery. Shenoticed from time to time, as she sewed , morepowder upon th e drops than seemed usual , bu t shecontinued quietly to dust them offas she ate, andwent on with her work. C an any tbing be mor e

absurdly trag ic t/zan tlzis unconscious su ici de, del iber

ately eating gum-drops powder ed w i t/t ar sen ic ?

Probably an hour and a hal f passed in th is innocentamusement

,when suddenly, becoming deathly

sick,instantly followed by intense pain , as i f, as

she quaintly expressed i t,

“ she had had a puremustard-plaster on the inside ofher stomach

,

” sh ewas roused to the consciousness that some strangem isch ief was at work . Terrified on rememberingthe arsen ic, She attempted , unsuccessfully, to re

l ieve her stomach with warm water ; then , unwill in g to alarm her mother, who was also an invalid,

she hastily threw on her dress and hat and hurriedto my office

,about two blocks away. Fortunately

for both of us,I had on my table a sample bottle

ofd ialyz ed iron (John Wyeth and as soonas she told me sh e had taken arsenic

,and before

She began her story,I administered a half-table

spoonful ofthe iron well d ilu ted in a tumbler ofwater. This gave her almost instan t rel ief. I re

peated th e dose in ten minu tes, and then gave hera bottle of the iron

,directing her to tak e a similar

dose every half-hour,and

,later

,every hour during

the day . I saw her at her home . i h a few hoursafter, but she had had no return ofher pain , except some S l igh t cramp in the lower bowel andl imbs and a dose ofmagnesia at nigh t, withmucilaginous drinks

,soft food

,wi th occasional

doses ofthe iron well dilu ted,kept up for a few

days,completed her cure. At my request

,th e day

after her attack , Miss S . put into my hands thepocket cut from the wrapper, which she could notbe persuaded to touch after her poison ing. ThisI transferred to a reliable analytical ch emist

,from

whose report of h is examination,now in my pos

session,I condense the fol lowing : In the pocke t

ofa C h intz dress I found a small packet label ledArsenic

,— Po ison.

— and in th is packet a secondenvelope

,Open on i ts long and upper side con

taining a white powder. Both outer‘

and Inner .

envelopes were worn as letters carried in pocketsare. Between the outer and inner envelopes wasa white powder, and in the pocket i tself, mixedwith th e powder, I found two (2 ) sugar-crystall iz ed ,soft gum-drops , and one ( I ) sugar-coated bon -bon

,

al l three 3 ) richly covered with the powder. Thepowder

,which with a brush I took away from the

gum-drops,and the dragée, weighed 35 gr ains ,

and th e remaining powder, after separating thegum and sugar, weighed 291; grains . In the pocketI found also 6%grai ns ofth e wh ite powder. Thepowder obtained from the gum drops and dragéegave al l the tests arsen ious acid gives . ’

What amount ofarsenious acid my pati en t swallowed

,i t is

,of course, impossible to say. I t i s

certain that from th is open package ofarsenic aconsiderable quantity escaped into the pocket

,and

the gum-drops were mixed with it, as she states“ that she had to dust the powder offup on herwork as she ate ,

” and the three remaining after,

S how 231?grains of arsen ious acid upon them on

exam ination by the chemist. I have perhaps beenunnecessarily ful l in the details ofthis case

,bu t

I th ink they have established severalfacts . I st ,that my patient did swallow, in the space ofan hour or more, numerous poi sonous doses ofarseniou s acid in powder ; 2nd , that I found herwith marked symptoms ofarsen ical poisoningand

, 3rd , that by the administration of moderatedoses of dialyzed iron , well diluted, I was enabledto give her immediate and certain rel ief

,an d ul ti

mate and entire restoration to health . I do not

THE CANADA LAN0ET.

propose in the l im i ts ofthis paper to d iscuss theexact chemistry ofthe d ialyz ed iron . I t is

,I be

l ieve (when properly prepared , as I have since investigated carefully the process ofits formation ),a solution ofperoxide ofiron in the collo id form ,

with perhaps a trace of hydrochloric acid ; butthat i t will

,when very largely diluted with water,

perfectly coagulate arsenious acid i n solui ion,any

one can satisfy himself in a five minutes’ test. Theonly remaining poin t ofin teres t professionally is,will i t neu tral iz e arsen ious acid when taken i n

powder (bulk) in to th e stomach ? I t is held bymost authorities

,I believe

,that when arsenious

acid is taken in bulk into the stomach , the ironantidote is not rel iable. (See Dunglison , R . J .( latest paper on the subj ect ), i n his Practit ioner’sR eference Book

,page Yet we know from

d a ily experience that arsen ious acid is absorbed bythe stomach when taken in minute doses

,and ]

th ink the evidence in the case shows that arsenicpowder did poison when presented to and actedu pon by a comparatively empty stomach (at l eastthree hours hav ing elapsed since her breakfast ),and that the solution of peroxide ofiron (dialyz ediron ) d id prove a prompt and reliable antidote ,coagulating and neutral iz ing the arsenic. Arsen ious acid acts as i t i s d issolved , and the antidote ( ifsupp l ied) combines, par i passu , with the solutionformed by the l iqu ids ofthe stomach, and rendersi t inert before damage is done to the mucous coatofthe stomach o r i t i s absorbed into the system.

With in twenty seconds after I learned that arsen i chad been swal lowed I sent a ful l dose ofthe antid ote after the po ison

,and with positive and im

mediate rel ief to the patient. My experience withd ialyz ed iron as a pleasant and effi cient means Ofintroducing Iron into the economy is too l imitedfor an Op i nion , bu t I feel d isposed , from the history of th is case , to strongly recommend it as asafe , rel iable , and always-ready-at-a-moment’s-not ice remedy and antidotefor arsenical po ison ing.

— D r . R eed , Medical Times .

TR EATMENT OF FR ACTUR ES OF THESHAFT OF THE FEMUR .

C L IN IC BYFR ANK H . HAM ILTON,M .D .,

NEW YORK .

F irst, I wish to remark that fracture ofthe shaftofthe femur in the adul t is almost always obl ique.The fracture i s usually very Oblique

,so much so

,

that i t almost never happens that we can set i t, in

th e ord inary sense ofthe term that is,we cannot

make the fragments set support ing each other.The fracture is so oblique

,that unless the frag

ments are maintained in position by extension andcounter-extens ion,» they always overlap each other.This is the law. There are exceptions

,of course,

as for example, when fracture occurs in a paralyz edl imb, etc.When the fragments overlap , there will be a pro

ject ion equal to the entire th ickness of the bone.Th is is i llustrated in the specimens you see here.In th is specimen the fracture took place aboutthe m iddle ofth e shaft

,and the overlapp ing

,as you

see, is as has already been stated, and the proj ectionis very marked.

The same thing can be observed in anotherspecimen

,in which the fracture occurred a l ittle

h igher up, very near to , but not involving the neckofthe bone. In th is case there was no extraor

d inary obl iquity, but the fragments overlapped eachoth er fully two inches the lower fragment rid ing upwards unt il it impinged against the neck ofthe bone.As a rule

,then

,there i s no such th ing as set

ting a fracture of the shaft of the femur,in th e

O rd inary acceptation ofthat term . The bone canbe placed in position

,and held there

,perhaps

,i f

suffi c iently powerful extens ion and counter-extens ion are employed, but i t does not set upon itselfso as to hold i tself.In this particular instance the plaster-of-Paris

dress ing was employed, and was applied while thepatien t was under the influence ofchloroform . andwh ile full extension was made w ith pulleys. Thesplint was worn for several successive weeks , andwhen the patient died, two or three years after, i twas found that just such shortening as the condition of the bone would perm it had taken placethe lower fragmen t had ascended until i t s truckthe neck ofthe bone. Practically, there -was noextension or counter-extension in the case.How is the tendency in the fragments to over

lap,from the action ofthe powerful muscles, to be

overcomeCertainly never by setting the bone

,as it is call

ed,and then binding i t t ight with bandages , be

cause you will have cut offall circulation in thel imb long before you can b ind i t sufficiently tigh tto maintain the proper position of the fragments.This is but plain common sense . No surgeonwould dare to attempt to treat fracture of the thighin that manner. H e may put on lateral supportsand apply bandages

,and the position ofthe frag

ments may be in some sl ight degree maintained bypress ing them against each other

,but th is dress ing

will not prevent shortening.

How then will you overcome the tendency toshortening PUnt il the latter part of the last century al l surg

eons from the earl iest periods employed the long,straigh t spl int. The method was generally tos imply pull the l imb out to a certain length , andthen bind a long

,straight splint to the side ofthe

limb and side ofthe body. The old-fash ionedlong splint is illustrated by th is ‘ s imple and p rac:t ical device employed by a surgeon under Stonewall j ackson ,

that great soldier and good man . I t

N

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130 THE CANADA LANCET.

Because the l igaments ofthe knee—jo int wil l notp t

'

lmit ofgreater extension w ithou t becoming painIf we stand in a position in wh ich the knees are

thrown back to their ful l extent, they soon becomepainful

,and the posit ion cannot be maintained

w i thou t great suffering.

We usually stand with the knees bent at an angl eofon e or two degrees , and if straigh tened morethey become painful .Some pat ients wil l bear fifteen

,some twenty

,and

some twen ty-two pounds extension,which i s the ex

treme amount that should be employed . By nom eans put on such an amount Of extension ascauses the patient pain .

A few years ago,at the suggestion of German

surgeons,who have done so much good and praise

worthy work , American surgeons began to u seplaster-of-Paris in the treatment offractures ofth efemur. In adopting that plan oftreatmen t

,th ey

went a step backward instead offorward,for th ey

adopted a method by which they could not secureany degree ofextension and counter-extension , asany one can satisfy h imself by watching a casethroughout i ts treatment. I t i s easy ofdemonstrat i on that i t does not afford any extension andcounter-extension . I f the plaster i s put on so thatpressure i s made on th e perineum

,i t wil l cause

u lceration . I have seen a case in wh ich ulcerat ion extended through the perineum

,and up th e

back six or eigh t inches, and as deep as my hand.

I f you do not use the perineum to make pressureagainst

,you must use the side ofthe th igh .

What k ind ofa surface does the thigh furnish PI t is an obl ique surface there is a gradual declinefrom the hip to the knee

,and inasmuch as the

plaster wi l l l oosen with in four or five days,so that

you can run your hand in b etween i t and the surface ofth e l imb , there is no counter-extension atall ; net th e sl ightest.The entire foot and l imb may be enclosed in

plaster as snug as you please, but you have no

coun ter-extension not a particle. While th eplaster was being used in this hospital , I saw moreshortening than I ever saw before in my life

,and

I saw two or three deaths, occasioned by the useofthe plaster-of-Paris dressing.These cases have been carefully recorded in the

sth edition ofmy work on Fractures.I think we have gone several steps backwards

when we use the plaster-of-Paris dress ing, and I amhappy to say that i t is almost abol ish’ed . At thepresent time there is scarcely one ofmy colleaguesin th is hospital who employs i t in the treatment offractures of the th igh there may be one

,but I am

sure you will not use i t more than once or twice incountry practice.The apparel

,when complete

,as I usually employ

i t, is generally known as Buck ’s extension . ButDr. Buck was not the firs t to employ the adhesive

are the most essent ial features ofthe treatment .So it is with other parts of the apparatus . We areindebted to Dr. Buck for a great deal in the treatment of fractures , but this apparatus has been solong employed in this country and so much modified that i t may with more propriety be calledAmerican . In th is case the apparatus is complete

,

and let us see what we have. fi r st,we have two

broad strips of adhesive plaster reaching from theknee to a few inches below the foot

,and secured

to the sides ofthe l imb by means ofa roller bandage . A piece ofboard is attached to the lowerends ofth e s trips ofplaster, and from the centreof the board a cord passes over a pulley fas tenedto the foot ofth e bedstead. In some of these casesyou will notice that we have two pulleys

,and in

others only one .Originally

,a simple stra ight p iece ofboard , hav

ing a mortise in it, as you see, and carryi ng a pulley

,was secured in the uprigh t position to the foot

ofthe bedstead. The upright seen here is ironand can be adj usted and removed with ease i t isan improvement that is, i t i s somewhat more conven ien t than the original wooden board .

The piece ofboard to which the adhesive s trapsare attached must be of sufficient length

,so that

when extension is made they will not impinge uponthe malleoli.

The strips ofadhesive plaster need not go aboveth e knee.

Then as to the counter-extension . We have , asyou see , no perineal band. We have simply raisedthe foot ofthe bedstead about four inches , andhave seen that the patient rests h is head

,not lzi s

s/i oulders, upon a pillow. We next apply four shorts ide-spl ints to the thigh three will not answer i t

is necessary to have four independent s ide-splints ,which nearly encircle the l imb. We are employinghere spl ints constructed offel t, which is made ofseveral thicknesses ofcotton cloth. This materialis on e of the best that can be employed for th isparticular purpose as i t is easily worked , i s sufficient ly flexible

,and at the same time possesses

suffi cient firmness.These s ide-splin ts are secured in posit ion simply

by encircl ing the l imb wi th four or five fi l lets and »

tying them with a conven ient knot. In this manner the fragments are kept in proper coaptation ,

‘

and the spl ints can be eas ily removed to afford anopportun i ty for inspecting the limb .

In addition,you see fastened to the side of the

l imb and to the s ide of the body a long splint,about

four and one-half inches in width extending nearlyto the axilla

,and having at the lower end a broad

cross—bar to prevent i ts tipping.

What is the use ofal l this fi rst, i t preventsevers ion ofthe l imb.

THE . CANADA LANCET.

a direct l ine.ture is pretty h igh up, or even in theof thefemur

,I regard the long side ‘

most essential part of th e apparatusthe broken femur in an absolutely

city.

ures,

until

mysel f in thatI t was found

or th ree weeks0 cut the Splinting it together

that i t becomes an almost absolute necess ity to expend a prodigiou s amount of labor in removing thed ressing ent irely every two or three weeks and applying another new splint.In nearly al l these

,cases treated by extension

and counter-extension there is more or l ess shortening. That is the rul e. In th is case the amount ofshortening i s three-sixteen ths ofan inch . Formerlythe average amoun t ofshortening varied fromth ree-quarters to one inch ; now i t is u sually one

hal f inch , or less.Here is a c ase

,gentlem en , in which th e plas ter

spl int has been applied for purposes ofil lustrat ion .

In order to secure extension even temporarily,

the plaster splint must be carried over the foot , andthen . i t must be extended up over the l imb andthrough the perineum ; th en i t i s carried aroundthe pelvis so as to embrace i t completely.If th is spl int remains on a week i t wil l be l oose

— indeed, i t is so loose now,and i t was applied th is

morning, that the hand can be sl ipped in betweenthe pelvis and perineum

,

affords noth ing in the wayis is the Ord inary method of using plaster-of

Paris in the treatmen t offracture ofthe th igh .

[Several cases were exh ibited and brief allusionmade to the pecul iarities in each .]— M ed ical R ecord .

ON Tnsr i cmss AND THE PR OC R EA'I‘IVE POWER.

Dr. H. A. Spencer, of Erie, Pa.,i n fli ed. and

S urg . R epor ter , reports a. case of the removal ofone test icle, wh ich was followed by no apparent

2

137

d im inut ion of the procreat ive power of the ind iv idual , he hav ing subsequen tly begat a number ofch i ldren .

CONVULSIONS IN TYPHOID FEVER .

C LINIC , BY J . M. DA C OSTA,M.D.

,PHILADELPHIA.

The rather sudden term inat ion of one ofour casesof typho id fever, towards the close of i ts th irdweek , makes i t incumbent on me th is morn ing toexplain to you the mode ofdeath , and to po int outto you some uncommon features of the speedyand unexpected end .

Just as convalescence appeared defin ite l y establ ished and the pat ient seemed out of danger

,he was

seiz ed w ith general con vulsions,and i n afew mo

ments exp ired .

After refresh ing your recol lect ion of the caseby read ing the cl in ical notes

,I propose to devote

the remain ing port ion ofthe hour to discuss ing thes ignificance ofconvuls ion as a symptom oftypho idfever, and i ts bearing upon the treatment of thediseaseAlbert McD. ,

a seamen before the mas t,was

brought,Dec. 30th

,187 6

,from sh ipboard into our

wards, wi th the statement that he had been s ickfor two weeks

,the prin rzi pal symptoms being great

prostration,fever

,headache

,and diarrhoea. The

remainder of the crew were heal thy, and no causewas assignedfor h is i l lness . He was 21 years ofage, unmarried, of good phys ical frame, and, to al lappearance

,a man oftemperate hab i ts.

H is ax i l lary temperature on the even ing of adm iss ion was During the n ight he was del irious

,

but the next morning he responded intel l igen tly to

quest ions,and gave a connected account of h is

i l lness. He stated that he had been suffering w ithd iarrhoea for a week before, be ing regarded as unfitfor work , and that he had been in h is berthfor onlyten days before admi ss ion, during wh ich t ime hewas pursued by strange dreams. The headache waspr incipally frontal

,and was severe and constant.

The record taken on h is adm ission into the hosp ital,

speaks of h is tongue be ing d ry and coated from the

centre to the edge,and d isplay ing a red wedge

shaped patch , i ts base correspond ing w i th the t ipof the tongue. The gums and teeth were coveredw i th sordes

,and the breath was offensive . There

was complete loss of appeti te the bowels weremoved twelve or fi fteen t imes a day , the d ischargesbeing watery . The abdomen was tympanitic

, and afew rose-coloured spots were seen on the lower partof the chest

'

and abdomen .

The k idneys performed their funct ion wel l , and thesecre t ion was of a l ight amber colour, acid i n i ts reaction

,ofspecific grav i ty 1020, and con tained a

small amount ofalbumen a m icroscop ical exam ina~t ion fai led to d iscover casts .

138

He was ordered d ilu te n i tro-muriat ic acid,ten

m in ims thrice daily,and eight grains of qu in ia dai ly.

To rel ieve the diarrhoea,he received supposi tories

ofacetate of lead and Opium During the nex tfewdays he gained rapidly

,and the temperature-chart

bowed the decl in ing gradat ions pecul iar to thisstage ofthe disease thus h is temperature ‘on

Dec. 30was 104° P . M.

Dec. 31 A . M . 10350 P . M .

Jan . 1 102? A . M . P . M .

Jan . 2 1 A. M. 102° P . M .

Jan,3 1 A. M. 100

° P . M .

Jan . 4th the temperature in the morn ing wasand the pat ient had a pu lse of96

,ofgood

volume,and only sl ightly heigh tened respiration ,

and n o cerebral symptoms yet he d ied in the

afternoon after a convuls ion last ing afew mom en ts .During i ts progress h isface became purple

,the

head was drawn back , the neck swel led he seemedto be gaspingfor breath

,and struggled so v iolently

that h is l imbs had to be held by the surround ingpat ients to prevent h is be ing thrown from the bed .

Pass ing by the m inor detai ls ofthe case,w e

notice,first, that the sta tement ofthe pat ient, thathe had been il lfor nearly three weeks

,was confirm

ed by the temperature observat ion s. The h ighes tpoin t marked was on the even ing of adm iss ion fol lowing th is

,the even ing exacerbat ions

,

after each morn ing’sfal l,showed a decl in ing ser ies .

Nor was the improvemen t to be found only in the

van ish ing fever heat there“

was n ofresh erupt ionofrose-coloured spots

,indeed

,those not iced upon

adm ission were gradually fad ing,the d ischarges

were reduced andb

under con trol , the tongue was

clean ing,and

_

he slept at n ight w i thout del i rium,

when , without warn in g or apparen t cause, w e no

t ice that he had a v iolent,general

,and rap idly fatal

convuls ion .fNow let us see ifthe autopsy explains th is um

looked-for resul t, or i s ab le to th row any l igh t upon

the cause of death . In cases ofsudden term inat ionof typhoid fever

,we natural ly th ink ofintes t inal

perforation , ofexhausting internal hemorrhage, or

ofcerebral effusion in the presen t case th is is n ot

a subject m erely ofspeculat ion,as we ' have the

organ s before us and i t i s to the ir appearance thatI in v i te your attent ion .

An twerp— Tho lungs

,with the exception ofsome

engorgement posteriorly from hypostat ic conges tion ,

are found to be heal thy and crepi tat ing throughout .There is no ev idence ofpleurisy ; there are n o ad

h esion s or effus ion . The hear t weighs 105» ouncesth e left s ide i s firmly contracted

,the ventricl e

being empty,the auricleful l offluid blood. The

right side seems flabby,the v en tr icle contain in g

some flu id blood and .a wh i te,fibrin ous clot

,th e

auricle hav ing flu id con ten ts an d n o clot. The

cav i t ies , wal ls, except as regards the flabbin ess ofthe righ t s ide

,and the valves appear healthy .

THE CANADA LANCET.

crease

look l ipatche

colourwhere a sign ofperforat ion .

The

he pronounces them to be in a state ofgrangenerat ion . The sup ra

-r enal capsu les are

The brain i s rather sOft, but i s '

perfectly na

gross exam ination .

Now,looking at the post-mortem resul ts, wefi nd

i n the k idneys alone sufficient groundfor the ex

planation of the convulsion seizure and i ts uraem i i

nature is further rendered most probable by th i

presence ofalbumen in the urine, and by the wel lknownfact of thefavouring element of the accumul

at ion in the b lood ofthe products ofwaste and disintegrat ion oft issue during the fever proces s. But

before we adopt th is v iew,let us consider wha‘

other causes may de term ine convulsions in typhonfever and thus see whether any of them i s l ikelyto have been at work in th is part icular case.

A pat ient may have a convul sionfrom overloadi ng the stomach . Every hospi tal surgeon know:that the friends ofthe s ick man have ways 0

elud ing the most Cerberus-l ike of gate-keepers , antare

,

thorough ly happy if they can con vey quan tit ies of apples and peanuts to the pat ien t tofi ll h istomach w i th when the attent ion ofthe n urse Idiver ted. The smuggled articles may have al l thiproverbial flavour offorb iddenfru it , but they ofteilead to d isastrous con sequences . Among these Ina;be convulsions

,and death may occur as the d i rec

resul t of paralysis of a heart already weak ened b )fever. We have a paral lel in the wayfeeble ch i ldren perishfrom convulsions brough t on by ind i gest ion . In the cas e we are discuss ing there was som i

suspicion of improperfood hav ing been g iven , buat the autopsy n one wasfound in the ‘

stomach .

Now as to the d i rect influence ofthe typhon

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140 THE CANADA LANGET.

major i ty of them,al though the connect ion between

th i s and the convuls ion may have passed unnot iced.

But i s al bum inuria always anteceden t ? Not toneedlessly obscure the subj ect in your m inds

,but to

warn you of a source offallacy, I must state that, insome cases offever

,there may be an excess of urea

and the products oft issue -waste in the blood, pro

gressing even to the product ion of uraem ic convul

sions, without the presence of albumen in the urine.

The secret ion in th is case is scan ty. The urea isfound in deficient quanti ty i n the urin e wh i le inthe b lood we find al terations produced by i ts presence, or of the substances i t gives rise to. W e mayhave to seek the adv ice of the profess ional chem istto determ ine th is point and I have more than oncebeen most efficiently aided in solv ing the obscurecl in ical problem by the sk ill ofour pathologicalchem ist, Dr. Hare. Again

,convuls ions

,at any

t ime and from any cause,may themselves produce

t ransient album inuria,so that the detection of al

bumen in the urine for a day or two after the attacki s not suffi cient to establ ish i ts uraem ic character.In cases where album inuria and undoubted dis

ease ofthe k idney ex ist,and convulsions have hap

pened, does the renal d ifficul ty antedate the fever,or, is i t a compl icat ion It may be e ither . Chron icnephritis grants no immun ity from typho id feveron the other hand, an engorgemen t ofthe k idney ,an accumulat ion of epi thel ium in the tubul es, and

the beginn ing ofa parenchymatous nephri t is are

met w i th,as part ofthe typhoidfever process

,and

may be sufficient to clog the k idney to such an ex

tent as to interfere w i th i ts funct ion . You w i l l askme

,

how are we to know if the k idney d isorder belongs to the fever or not ? W e cannot always know.

It is true that cons iderable quan t i t ies ofalbumen ,the presence ofmarkedly g ranular or fatty castswou ld determine the antecedent nature ofthe malady. But some tube casts may also befound inthe urine com ing from the hyperaem icfever k idneys and we may n ot detect them at one exam in

at ion in the urine of a chron ic renal affect ion . The

presence ofalbumen from the onset of th e feverwoul d greatly favour the supposi t ion of the latterfor in typhoid fever album inuria is not an .

ear lysymptom. Again

,we may have the lesions deter

m ined by the fever process adding to the embarrassment of an al ready d iseased organ ; and thus producing the inact ion wh ich has led to the uraem icseizure. Such I take i t happened i n the case wh ichwe have been d iscuss ing th is morn ing.

Now, I have conveyed to you a wrong impress ionifI have led you to suppose that convuls ions musta lways happen in consequence of the uraemia m et

w i th in fevers. Coma is,perhaps

,the more common

resul t ; or a state of hal f-coma w ith convuls ivetw i tch ings . W e have recen t ly had a case ofuraem ic coma in the hosp i tal wh ich some of you haveseen.

But I must revert to the subj ect I have been at

der j ust ifies the most hope.

The treatmen t,too

,w i ll

knowledge of the cause. Ihow important i t i s to takedown waste is n ot retained

potent alsocase alwaysthe pat ientto brain or

vessels,or from the extreme deb i l i ty that atten

the fever . In decid ing th is the pulse and the st:

ofthe first sound of the heart are our ch ief guidBrit I can not nowfurther en ter i nto th i s subjeri t involves much , hav ing a w ider range than can

accorded to my d iscourse. Let me only add thif the convuls ion be due to apoplexy, and associatw i th on e-s ided palsy

,the abstract ion of blood see

brom ide ofpotassium w i l l bBut , whatever t reatmen t beact ive

,and take into account the

d it ion wh ich has occasioned theNews and Lib rary.

CLOSUR E OF THE VULVAFO R VESI (VAGINAL AND R ECTO-VAGINALFTULA.

BY DR . GOODWILL.Thirteen years ago th is woman Went in to 1

first labour,during which she was attended

two most excellent obstetri c ians. I t happenecbe an arm presentation, giving no chanceturning

,but showing a tendency to spontane

evolut ion . Wh i le one physician was away andother asi eep the ch i ld was born . As a re

'

sulthese complication s she

THE CANADA LANCET.

e artery spurts,which I secure at once

fine. Scissors do not always behavesuch circumstances the edges may noty true stil l I prefer their hal f cr ush ingthat ofa knife . They do away with aof bleeding. You notice that I have

sides accurately together and seeJ ust here at the entrance to thework with great caution . I f any

are

;m essages THE W O N OFAN STM H C S

membrane needful on each side IN LABORsutures. Butnymphae,for M P i achaud read a paper before the Inter

only interfere national Medical Congress ofGeneva in which hes ides . These advanced the following conclu5 1ons

t I must resist I.The employment ofanaesthetics is, as a

general rule,advisable in natural labor.

2 .The principal substances which have been

lower margin ofth e arms, and pass i t through one

s ide w ith a sweep . Always bring out the stitcheson th e edge of th e denuded surface . I do not ex

pect th is to be nearly as successfu l an operation asthat for perinaeum . I have passed eight su turesthrough . I have included plenty of tissue in mystitch es so that they won ’ t tear ou t. For . th is purpose I thrust the needle straight back at first andthen bring i t round. If these sides do not healcompletely I shall have to open th e wound again.

At the last stitch and that nearest the symphysispubis I have pas sed my needle and wire all th eway round . The great diffi culty always is to seethat the points Ofexit and ofentrance ofthesutures are exactly opposite. Now I am ready todraw the sides together. As I tigh ten each sutureI syringe

'

out the part carefully so as to wash awayal l the urine from the s ides Ofthe wound . I nclamping the su tures I must use very large shot inorder to make the fastenings secu re. I wil l use twoclamps for each ofthese lower stitches . The mostd iffi cul t stichfor heal ing is the last, that j ust at thesymphysis pubis. All the sutures are now fastened.

I t makes,you see

,a very clean apposition. I

shal l have a sigmoidal catheter passed through therectum into the woman ’s bladder, and the rectumdrained by a flexib le gutta—percha tube. O f courseher knees must be bound together, and she mus tbe given Opium enough to

‘

dull the pain and keepher bowels locked for eight or n ine days. Be surethat you always put a pad between the knees before binding them together. [When the stitch eswere removed ou the nin th day, the un ion Ofthesides were found to be complete except the si te ofthe meatus urinarius. At this S pot a smal l fis tulousopening remained

,througi which the urine trickled

out. The doctor attributed this opening to th efact that, underest imating the strength of thesph incter ani , he had used a flex ible catheter instead ofa silver tube to drain Ofi" th e urine, andthat the contraction of the muscle had closed the

catheter and so forced the urine to find anothermeans of egress. He further stated that he wouldattempt the closure Of the fistulous opening bycutting flaps from both sides. This secondaryOperation he would postpone for a couple ofweeks .until the patient had time to regain flesh andstrength .] —B oston M ed . y ea r ned .

142 THE CANADA.

LANC ET.

u sedfor this purpose up to the present time are

ether,chloroform

,amylene

,laudanum

,morph ia

hypod erm ically,chloral by the mouth and by

inj ection .

3 . Of these chloroform seems to be preferable.4. I t should be admin istered according to the

m ethod ofSnow, that is, in small doses at thebeginning ofeach pain, i ts administration beingsuspended during th e intervals.5 . I t should never be pushed to complete insen

s ibi li ty, but the patient should be held in'

a state ofsemi-anaesthesia

,so as to produce a diminution of

the suffering.

6 . The general rule is never to adm inister chloroform except during th e period ofexpulsion ; butin certain cases ofnervousness and extreme agi tation it is advantageous not to wait for the completed ilatation ofthe os .

7 . Experience has shown that anaesthetics d onot arres t the contraction s ofthe uterus or '

abd om i

nal muscles, bu t that they weaken th e naturalresistance of the perineal muscles.8 . The use ofanaesthetics has no unpleasant

effect on the m ind ofmother or upon the ch ild.

9 . In lessening the suffering,anaesthetics render

a great service to those women who dread thepai n ; they d immish the chances ofthe nervouscrisis which are caused during labor by the excessofsuffering ; they make the recovery more rapid.

1 0 They are specially useful to calm the greatagi tation and cerebral excitement which labor oftenproduces in very nervous women .

I I . Their employment is indicated in naturalcases until the pa ins are suspended or retarded bythe suffering caused by maladies occurring previousto or during labor

,and in those cases where

irregular and par tial con tractions occasion internaland sometimes continuous pain

,withou t causing

progress ofthe labor.1 2 . In a natural labor

,chloroform should never

be used without the consent Of the woman and her

M . Courty advocates the use Ofchloroform .

He thinks i t indicated when the pains are verygreat and irregular

,or where the patient demands

i t.

M . Leblond prefers to use the hydrate ofchloral .G az ette Oct. 20

, 1 8 7 7 .— M ea

’. R ecord .

PO I SON ING W ITH TOBAC C O .

— A s ingular case ofnarcotic poison ing in a ch i ld has been the subj ectofan inquest during th e last week. A boy, agedthree or four years

,was playing with other ch ildren

who were blowing soap bubbles . The father of thechild gave him an old

“wooden pipe,which had

been lying by on a shelf for more than a year.The deceased was qu i te well at the t ime

,but, an

hour after using th is pipe,he became s ick and

d rowsy. A med ical man was called in,and he

po isons — B r i t. M ed . y ear ned ,

MED IC AL LEGI S LATION INino is State Board of Health isto the physicians ofth is Stanew law.

A. This new law gi ves al l

those thus giving offence . Asstands there Will be C harlatans

,

framed that wi ll completelyQuacks are such by NATURE .

ways expect to be pestered byTh is new law places in our ban

i n our S tate izz'

rtory ,the poss ibi

no s ign ofrallying. He died onafter using the p ipe.The medical wi tness attributed

O tine which the wooden pipe hadtained . The deceased wh ile blowwith it

,had sucked in suffi cient

powerfu l po ison to cause the symand to prove fatal .There can be no doubt that a v

ty ofn icotinech ild of this a

al l physicians practising in his county.

n ew comer can be investigated,by any man

ing to ascertain if the former is registered ,Specting the County Clerk’s record . Ifhegistered , wel l and good if not, the Countyney, in Obedience to instruction s from theBoard, w i ll prosecute the new comer, whoshow that h e is a graduate

,or “move on .

the profession can keep out 0

fed , ungraduated men .

B. After January I st ., prolecting fees in courts, mustlaw-abid ing citiz ens , in thatby conforming to the laws Ofthat they are l icensed practitiosurgery. Failing in this

,they

ly in their su’

i t’

and be greatlyc. A]

quacks,

c

entering

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144

5 . In hospital out-patien t practice he prescribesfive grains thrice daily in half a drachm of glycerineand water

,and if not suffi cien t to produce effects

,

four times daily. Elsewhere he gives the samedose every two

,three or

'

four hours,according to

the urgency of th e case .6, There does n ot seem to be much danger in

large doses ofcroton-chloral. Dr. R inger hasgiven i t to a patient in five grain does every

‘

hourfor a fortnight

,and Dr. Liebreich a sleeping

draught con taing a drachm and a half ofthe remedy.

7 . Usually no unpleasant effects are observedafter ordinary doses

,though giddiness

,headache

,

and vomiting have occurred in afew cases . I ftaken immediately after meals

,emesis wil l usual ly

cease — (Medical and S urgi cal R eporter .)

A NEW MATER IALFOR D ILATATION or THECERVIX UTER I .— (Med . R ecor d , July 1 4th ,Dr. S ussdorfl

,after an experience oftwo years in

the use oftents made of the root ofth e Tupelotree, heartily recommends them to the professionas being far superior to sea-tangle or sponge. Thetree is a species of Nyssa indigenous to the UnitedStates, and ofth e five different k inds the NyssaAquatica is to be selected for making the bestten ts . I t i s a Southern species and grows inswamps and wet places ofGeorgia and Florida.The ro ats are the parts used

,and though very

heavy when firs t dug up,after being cut in to small

er pieces and exposed to dry heat they becomedry and l ight as cork . Messrs. Tiemann 81 Co. ofNew York

,now prepare them compressed to a

graduated scale. The advantages claimed forthese tents are, that : I . They are easily introduced , being smooth and firm . 2 . They will noteasily fal l ou t ofplace as they are very ligh t andsoon absorb moisture suffi cien t to retain theirplace. 3 . They are probably ofan antiseptic naturethemselves, as they do not decompose the fluidsw i th wh ich they are in contact have none ofth eoflen siveness always accompanying th e sponge -

or

sea-tangle, and being purely vegetable, are n ot

l ikely to produce septic poison ing or local i rritation . 4. The rapid ity with which they wil l expand when in con tact with the tissues and secretions ofth e uterus is perhaps on e oftheir ch ief advantages . This rapidity can be controlled by selecting ten ts compressed to different degrees ; thusone compressed to one-fourth of i ts original siz e

,

would not dilate so quickly as on e reduced to onetenth ofthe same — (D etroi t M edical y et/m al.)

HYDATID TUMOR OF . THE K IDNEY SUC C ES SFULLY TREATED BY AS PIRATION .

-Bradb ll ry.

(B r i tt'

s/1 M ed .ffour rzal , 1 87 7 , Oct.“ .

A boy,aged 8

,was admitted into the hospital on July 5 th ,

1 8 76. His only complaint was ofan enlargedabdomen . A large tense elastic swell ing occupied

THE CANADA LANCET.

fthe nipple in the n ipple-l ine

,and tracing it to the righ t, i t became separ

ated from the l iver-dullness (right lobe) by a bandofwell -marked resonance. I t then passed down ,abou t on e inch and a half to two inches to therigh t of the mesial l ine and los t itself below in thedullness ofth e (full) bladder. On tracing i t to

the left,th e dullness reached as high as the left r i b

in the axillary l ine,but at th is level i t d id not qu i te

extend to the spine. The whole of the left hypochond rium was fi l led w ith the tumor, and therewas complete dullness down to Poupart

’

s l igament.The percussion was tympani tic over the rest ofth eabdomen . At the upper part ofthe tumor the“repercussion thrill” could be obtained. The

heart’s apex beat immediately beneath the n i pple ,j ust und er the fourth rib heart and lung sounds ,urine and l iver were normal .On July 6 th , th e needle ofan aspirator was 1n

troduced in to the tumor, and forty-four ounces ofhydatid fluid were drawn off. No booklets werefound in i t. After the operation the boy vom i tedseveral times

,had slight fever, and an erupti on of

urticaria but no tenderness of the abdomen. Theurine was found to contain albumen, due to th epresence ofpus. July 1 5th , th e abdomen was en

larging again . When th e boy was made to srt upin bed he complained ofpain in the loins, and fouro f the lumber spines were found to be prominent ,and the skin over them reddened . They werevery painful on pressure. The tumor was aspirated again

,and th irty-one and a halfounces of a

green ish opal escent fluid were withdrawn wh ichin the latter s tage ofthe operation , was flaky andapparently purulent . After standing, the fluid deposited two ounces ofpus . Under the m i croscope

,pus -cells and the heads ofnumerous ech in

ococci armed with booklets were detected . The

boy vomited again several times after the operation

,bit t no urticaria fol lowed the second puc

ture. On July 2sth and a6 th smal l cysts withbooklets were found in the urinary sediment. Fromthis time th e pat ien t became gradually better. InNovember he was discharged from the hospita land under observation for some months. Whenlast seen

,he was quite well , the abdomen be i ng

perfectly normal and the urine free from pus andalbumen . C /zicago Med ical y ournal .)

OPEN AIR TREATMENT OFPHTH Isrs .— O ur

obj ect should be to find for our patients the cl imate so mild that their l ives may be passed ln open .

ai r .

In the Hawai ian Islands we have such a cl imate,which, in its average temperature and in equabil ity,may be said to be perfect ; where consumpti ves canliterally l ive in the open air withou t fear ofthose

THE CANADA LANCET.

sudden changes so object ionable in nearly al l thenoted retreats for inval ids.These islands are s ituated between degrees 1 9

and 2 2 north lati tude , in th e region ofthe tradewinds

,wh ich blow with great regularity abou t ten

months ofth e year. Although lying with in thetropics

,where th e heat might be expected to be

oppressive and debil itating,the temperature i s so

mod ified by the constant fresh breez es comingover the wide expanse ofthe ocean , that i t doesnot appear to be so great as the thermometerind icatesSays the historian, Jarves The cl imate i s

everywhere salubrious , and possesses a remarkabl eevenness oftemperature, so much so that th elanguage has no word to express the general ideaOfweather. Physiologi sts give a certain poin t oftemperature as most conductive to heal th andlongevity. The mean heat ofthese islands ap

proaches near to i t, and is highly favorable to th eful l developmen t and perfection ofthe animaleconomy) ? Again , when speaking Ofcertainlocali ties as favorable for consumptives

,he says :

" Many individual s by change ofresidence,have

prolonged their lives for years, and others l ivewith scarcely an admonition oftheir diseas e

,who

,

in less favor r

ed regions ofthe North , were perpetual suffer rs.”The mos t avorable situation s for such patients

are Honolu u , on the I sland of Oahu , Lahaina andU lepaleku t on Maui

,Kailua on Hawaii

,and Ewa

on Kauai,as

'

these places have the best tempera

turesfor constant ou td oor l ife, and afford comfortable residences for inval ids.The mean temperature on or near th e coast Of

all th e islands is with but l ittl e difference between summer and winter— i t being 79

°

for thewarmest months and 7 2

° for the coldest, showinga difference in mean temperature ofbu tDuring an observati on oftwelve years at Hon

olulu, the maximum ofheat was and theminimum a difference through that long periodofbut 3 7 °At Lahaina

,during an observation of ten year

'

s,

the h ighest register ofthe thermometer wasand the lowest a difference in one decade ofonlyBut a range so great as that i s very unusual.

During my residence at Lahaina offour years, the

max imum was and the minimum wh ilethe general average for the summer months was8 2

° at mid-day,and about 7 2

°for the win termonths — D r . W/zi te

,Kings

NEw METHOD OFR EDUC ING D I S LOCATIONS OFTHE SHOULDER (New York M edical y our nal ,October, — Dr. Kuhn descri bes a newmethod ofreducing dislocations of the shoulder.

145

THE DOCTO R’

S APPEAL AG AINST THEINC OME TAX.

COLON IAL MEDICAL DEG R EEs .— Some time

since the General Medical Council passed a resolution recommending that medical m en possessingcertain colon ial diplomas and degrees

,should be

placed upon th e M edical R egi ster . This,how

ever,can only be dOne by an amendment ofth e

Medical Act. Most of th e Canadian CollegesHe call s attention to the fact that there is a loss which confer medical degrees, and those also

offorce, due to the scapula following the tractionmade on the humerus

,in th e method Ordinarily

employed to reduce luxations Ofthe shoulder-j oint.He claims, on the contrary, that by making th ehumerus the fixed point

,and reducing the scapula ,

th ere is no loss Of power,and the resi stan ce of

those powerful muscles,th e pectoralis maj or and

latissimus dorsi,i s obviated . With a pass ing refer

ence to anaesthetics and to the prej udice wh ichsome practitioners entertain against th e ir u se

,he

proceeds to the modus operand i . A wedge-shapedcush ion is placed in th e axilla

,th e -base ofthe

wedge being downward ; the surgeon , s tanding atthe patien t’s side

,l ightly draws the arm downward ,

and at the same time fi rmly presses i t firmlyagainst th e pad in the axilla

,so as to make i t into

a lever ofthe first kind then,taking th e inferi or

angle of the scapula in the other hand,he raises

that bone and gives i t a seesaw motion . C oapta

t ion soon follows,the two parts returning to their

natural position by a simultaneous effort made on

the lower extremity of the humeru s and the inferiorangle of the scapula. I f the head ofthe humeru sbe displaced forward

,th e angl e ofthe scapula

should be directed outward at the same tim e thati t i s rai sed . I t should be directed inward if thedislocation be backward. I f any difficulty be experienced in making th e reduction , th e task ofholding and directing the arm should be confinedto an assistant — M ed . Times .

Thefollowing lines were written by a coun try surgeon ,in

1842, claim ing exemptionfrom the incom e tax. The authorh im selfrecited them when appealing . W e believe that thisi s the first time the lines have been published .

I’m sorry to make so sad a confession

Ofthe profits that emanatefrom my profession ,But thefact is , that most ofthe villages roundW ith surgeons , quack doctors, and d ruggists abound ,S O m uch so, that I am unable to clearThe sum ofone hund red and fifty a year.It would give me m uch pleasure could I return double, .

And save myselfall this add itional trouble .

But opponen ts and bad debts beyond al l redemptionC ompel me to fill out this claim ofexemp tion .

And what makes the matter so very much worse,I’ve a wife, and three child ren , and no private purse.

S Ofrom these simplefacts the collector must seeH e can gather

'

no tax upon incomefrom me.

S tuden t’s 7ou rmzl and H osp ital G azette.

THE ' CANADA LANCET.

e stabl ished at Barbadoes , Tasmania, New Zealand,and South Austral ia, will befavourably affected ifthe resolution be carried ou t — [fosp i tal G az ette,L ondon .

MAL I GNANT AC UTE R HEUMATISM .

— D. Jul iusP ollock , Sen ior Physician to Charing Cross Hosp i tal, London , says , in a recent lecture in the l ancet — Every now and then , fortunately not Often

,

rheumatic fever assumes a form for which I th inkthe term mal ignant ” is most appropiate. In suchcases

,without any apparent reason , the tempera

ture begins to rise , and may ultimately attain theh eigh t Of 1 10

° Fahr. , or even more the j ointaffection subsides

,pain is no longer compla ined

of, and the pat ient often expresses h imself as better

,j us t as the most seriou s symptoms are coming

on . The profuse sweating ceases,the skin be

comes dry, harsh , and intensely hot to the touchvery frequently a crop Of sudamina breaks out

upon the neck,chest, and abdomen (a very favor

able sign ) the tongue becomes dry and brown ,there i s great th irst

,complete anorexia

,the breath

ing is rapid,and the pulse very quick and gener

ally weak ; th e patient is tremulous and restless,with a suffused and “ ferrety ” appearance lookabou t the eyes. Low muttering deliuium is generally present

,though occasionally there is some ex

citement, and unless the disease takes'

a favorableturn, or rel ie f can speed i ly be given, death ensuesin a day or two , apparently from mere hyperpyrexia. Post-mortem exam i nation gives us no clueto the cause of the excess offever. In the cases Ihave examined there has been no pericarditis

,

though, I dare say, i t i s occasional ly present.Certainly its exis tence is not essential to the hyp erpyx ia. The lungs are dark and congested

,the

l iver and S pleen friable and easily broken down,

the blood is tarry and fluid, but the muscles areremarkable for their bright red color the .kidneysare unaffected. The Odor ofsuch ‘ cases

,even

when recently examined , i s generally most Offens ive.I am aware that this state ofhigh temperature is

not pecul iar to rheumatic fever 5 that it occurs incontinued fevers, in d iseases ofth e bra in and spinal cord , in pneumonia and other disorders ; buti t is in acute rheumatism that it has attracted mostattention

,and is most frequently encountered. I t

i s not on ly'

the more severe attacks ofthe d iseasethat dri ft into p erpyrex ia comparatively mild andsubacute cases , wh ich appear to be doing well, ‘

wil lnow and then take this remarkable course.I use th e term malignant for th is cond ition,

in the same sense that i t is u sed for those terriblecases ofsmall pox, scarl et fever, or cholera, inwhich the chief force ofthe disease seems tofallupon the nervous system

,overwhelming the patien t

before any d istinctive symptoms are manifested,and because, from my own

(experience, and that of

others, I have come to the conclusion that , in thepresent state ofour knowledge , the greater numberOf such cases die, in whatever way they may betreated. Indeed

,I think it is doubtful

,i n those

that do recover, how much the remedies had to dowith the result and Dr. Cavafy has recently re

corded th e case Of high temperature in acute rheumati sm that got well under the influence of foodand stimulants only — M ed. é

' S urg . R epor ter .

LOC AL TREATMENT OFDvS ENTER y .— Dr. H .

C . Wood, in the P/zi ladelp /zia Med ical Times ,speaks ofthe rational ” treatment ofdysentery asthe appl ication to

,

the mucous membrane involvedofa solution of nitrate ofsilver . From the value ’

Of this sal t in sore throat he thinks i t should beequally useful at the other end ofthe intestinaltube. R egarding dysentery s ir

'

ripiy as colitis, bymeans ofa long tube carefully passed 8 to 1 2

grains into the rectum , he introduces about 3 pintsof l iquor containing 40 to 6 1 grains from a reservo ir above. I t can flow in gradually by gravity

,

and must be about the temperature of the body.

If too hot or cold, per istal is is too easily provoked.

I f not n eturn ed in ten m inutes, a solution ofsal tcould be inj ected. He has tried it in one case ofdysentery

,and in several ofd iarreoea.

— TaeD octor .

SULPHATE OFC INC HON ID IA As AN ANTIPER

IOD IC .—Dr. H . L. Warren , ofI ll ino is, writing to

the C'

lzicago M ed ical y our rzal aad Exam iner,says

I have recently noticed two or three articles withreference to subst itu ting sulphate of cinchonidiafor sulphate Of qu inia

,the writers claiming that the

cheaper drug fulfi l led every indication met by quin ine . I know that many physicians are not awareofthis fact , and wish to add my testimony to thatalready given .

‘ I find that in malarial fevers ofwhatever type

,the cinchonidia sal t has proved jus t

as certainly a specific as the salt ofquinia. Havinghad a large number ofcases ofth is class t reatedalmost entirely by the drug in question

,I have

learned to place just as much confidence in it as Ihave had in quin ine

,and with equal confidence

predict a favourable resul t. I t has not failed in asingle instance to prevent to prevent the next paroxysm in a tertian , and the next but one, sometimes the next

,in a quotidian ague, and is equally

efficacious in remitten tfever,be ing wel l borne by

the stomach,and not producing any ofthe un

pleasant head-symptoms which so certainly followlarge doses ofquinine . I administer i t in fivegrain doses

,e ither i n pill or powder, as the patient

desires,every four hours, day and n ight, without

any reference to paroxysm,intermission , remission,

or exacerbation , until the patient has passed safelythrough the “ chill day ” in a tertian ague

,and

through two days without ch ills in quotidian thencontinue in smaller doses, say two grains after orbefore each meal. Considering the fact that qui

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THE CANADA LANCET.

Dr. H . F. Lyster read a continuation of his

paper heretofore presented on the subj ect ofHealthy Homes. He con sidered the subjectmainly with reference to their location and the

measures to be taken to secure good drainage,and

traced much ofthe ill health Of people to dampnessin and about their dwell ings . He had issued a

circular to the correspondents of th e board,and

with th is paper he presented the substance Ofabout40 repl ies received, showing the nature ofthe soil,practice as to til e-d raining, sources ofdrinkingwater, character ofcellars , disposition ofdecomposing organic matter, etc. , about the homes in the

several local ities. He recommended that where

ever the soil is not dry there should be tile-drains

around the house or under the cellar.

In th e discuss ion wh ich followed,Dr. Baker

deemed it important that such drains should never

communicate un in terupted ly with a sewer, whichmay contain sewer gas which will thus permeate

the house but the connection should be through

an open-air space or Otherwise freely ventilated, On

th e house side ofth e trap.

'

Dr. Kedz ie said that if box drains be used theyshould be placed with on e corner down , so as tobe self-C leansing.

Dr. Kedz ie read a paper on persistence in effortsto R esuscitate th e Drowned.

” He reported a

large number ofcases where persons had been re

suscitated a long time after they had apparen tly

ceased to l ive. He claimed that deaths are constan tly occurring for lack of thorough efforts at resuscitation , and that whenever such efforts aremade they should be continued at least two hours .

He cited one instance where only after six hours

Of constant work d id symptoms ofl ife appear, andyet this person was completely restored.

The secretary read an outline Of a report ofthework ofhis Offi ce during the last quarter. I t in

cluded the distribution of about five thousandcopies ofth e document on R estriction and Preven tion Of Scarlet Fever

,

” and sixteen hundredC opies of the Fourth Annual R eport Ofthe Board 5th e printing of

,

s ix thousand copies Of the document on the Treatment of the Drowned.

” Much

time had been given to the compilation of“WeeklyR eports of D iseases

,

” and a large amoun t ofmiscellaneous correspondence and other businesstransacted.

Hon . Leroy Parker read an abstract ofpapers

BRANT COUNTY MED ICAL AS S OC IATION .

readbefore the publichealth section Ofthe Americansocial association at Saratoga, which he had at~

tended in th e interests ofpublic h eal th in Mich igan .

Dr. Hitchcock presented a report and a b

stract ofpapers read at the recent meeting oftheAmerican public h ealth association at Chicago.

At the last meeting ex-president Hitchcock pre

sented an address by title,and at this meeting it

was read. The subj ect was Heredi ty in its re

lations to the publ ic health, and to legislation in

the in terests Ofpublic heal th .

”

A valuable paper on the diet ofinfants, by Dr.Arthur Haz lewood, of Grand R apids, an ex-member Of the Board

,was accepted with thanks.

The secretary read communications from Dr. G.

W. Topping of Dewitt, relative to reports of prevail ing diseases from Dr. 0. Marshall ofth is city,on the subj ect ofOpium-eating from Dr. Edward

Do'rsch ofMonroe, on l ead-"

poisoning,from: tin

cooking utensil s l ined or glaz ed with lead fromDr. C . W. Marvin ofI thaca, relative to the recen tincrease ofdeaths from cancer ; from Dr. J . D .

Hull ofAllegan County, relative to drainage in hi slocality ; from Dr. Batwell ofYpsilanti, relative tosickness from damming the Hudson river ; from

Dr. Charles H . Fish er of R hode Island, gi vingformula for preparation and an account ofthe first

use of sulpho-carbolate ofsoda as a preventive inscarlet fever.

Dr. Lyster presented a paper on baths and bathing . He gave a history and description Of all

kinds ofbaths and their effects on the human body.

His paper was also accompan ied by numerousrepl ies on th is subj ect from correspondents oftheboard to a circular wh ich he had issued .

The above Association convened at the Kerby

House, Brantford, on Tuesday Dec. 4th. Mem

bers present were Drs. Phil ip, Burt, Griffi n , Kitchen , Marquis, Harris, Sinclair and Healy. Stepswere taken towards forming a Divisional Asso

sociation,embracing Erie and Niagara d is tri ct.”

A paper was read by Dr. G rifli n On R ectal Abscess,and on e by Dr. Healy on Chorea . Dr. Philipshowed a case from his practice, and Dr. Burt apathological specimen . Drs. Marquis and Sinclairwere each requested to give papers at the next

regular meeting.

THE CANADA LANCET.

THE CANADALANCET.

A Monthly Journal ofMedi cal and Surgi cal S ci enceIs sued Promp t ly on th eFi r st ofeach Mon th .

fl C om m u n i ca t i o n s s o l i ci te d on a l l M ed i ca l a n d S et

e n t ifi c s u bj ects , a n d a ls o R ep or ts ofC a s es occu r ri n g i n

p r a cti ce . Ad ver t i s em en ts i n s er ted o n th e m o s t laber a l

ter m s . Al l L e t ter s a n d C m n m u n i ca ti on s to b e a d d r es s ed

to t h e “ E d i tor C a n a d a L a n ce t ,” Tor on to .

-AGENTS .— DAWS ON B R OS Mon t real ; J . St A. MCMILLAN ,

S t . John ,

N.B . ; J . M. BALDWIN , 805 Broadway , New York ,an d BALLIER E,TINDALL C ox ,

20King Wi ll iam s treet , S t ran d ,Lond on , Eng land .

I

TOR ONTO , JAN. 1, 1 8 7 8.

THE PAST YEAR .

Another year has come and gone, and another

leaf has been added to the h istory ofmedicine int he nineteen th century. The retrospect is an in

teresting one, and although nothing very startling

in the domain Ofmedicine has to be recorded, yett he rapid and steady progress which i s being made

i n al l departments is very gratifying, and we maybe pardoned if we refer with pride to the great ad

vances which are being made in our noble profess ion . As time rol ls on we find ourselves at each

recurring year,a long way in advance Of what we

w ere at the close ofthe las t; The departments ofmedicine

,surgery

,Obstetrics,therapeutics and phar

macy have been almost completely revolutioniz ed

with in afewy ears past, and yet much remains tob e done . Preventive medicine too, has had a

large share of. attention , and has given birth toa l iterature special ly its own . This branch Of th e

s cience ofmedicine is every year enlarging i tsscope and extending its usefulness

,and will force i t

s elf upon the notice ofth e Legislatures ofevery civili zed country. Sooner or later will be establ ish ed

State Boards Ofp ubl ic Heal th by every nation ,and government

,and measures adopted for the

promotion ofhealth and the lessening of preventibled iseas es . These things are. all in the near fu ture ,and the sooner a wise foresigh t on the part ofours ta tesmen l eads them to consider these matters

arigh t,the more credi table wil l i t be to their wis

dom.

The world’s Medical Congress met the pas t

year at Geneva,and remained in session four days .

I t was announced that several wel l known phy

s icians were to have taken part in th e proceedings ,but the reports of the meeting which have reached

us,have been very meagre regarding the ~success of

the meeting. In the field OfMedicine and Therapeu tics much progress has been made

‘ during the

year. Further and more extended experimentshave been made regarding the action Of sal icyl ic

acid in rheumatism ,ar

‘

1d as an an tipyreti c in fevers ,and wi th gratifying res iIlts. The influence ofthismedicine in lowering the fever heat and diminish

ing the excited pulse,is as marked as i ts power

to relieve pain . In cases oftyphoid fever wi thhigh temperature

,i ts use has been attended with

very beneficial resul ts in diminishing the excess ive

fever heat. I t is generally combined for adm in i s

tration with soda, and glycerine or syrup oflemons.Only in afew cases have any unpleasant effectsbeen Observed from its u se : A new preparationofth is remedy has been lately manufactured byMessrs. Evans C O .

,of Montreal , vi z .

,granulated

effervescen t sal icyl ic acid,and effervescent sal icylate

ofsoda. These‘ preparation s are very elegan t inappearance

,and palatable to the tas te as compared

with the crude drug,and will

,no doubt

,come into

general use. A new and simpl e treatmen tforburns and scalds has lately been brought under the

notice“

ofthe profession by Dr. Waters , ofBoston.I t consists in the immediate appl ication ofbicarbonate ofsoda to the scalded surface

,which almost

instantly rel ieves the pain and promotes the heal ing

process. The soda is dusted over the burnedparts

,and a wet cloth appl ied and retained— a

singl e appliCationi

being generally al l that is n ecessary. In th e treatment of epilepsy

,bromide of

arsenic has been used with varying resu lts . I t

was recommended by Dr. Clemens,Of Frankfort

,

who has used i t in his practicefor several yearswith mos t gratifying results. In some cases inwhich i t was tried by other observers i t proved

serviceabl e in checking the fi ts for a time at leas t,

and greatly diminish ing their frequency in others.It may be administered in the form ofbrom ide ofpotassium and ‘ l iquor arsen icalis, or prepared by

adding one and a half drachms ofpure bromine toeigh t ounces ofFowler’s solution, and given in fromtwo to four minim cl oses.

The treatment ofdiphtheria has come in for amore than ordinary share ofattention during thepast year. This interest was heightened by th e

fact that this disease has prevailed pretty exten

sively in d ifferent parts OfCanada during the year.The use ofsulpho-carbolate Of soda has

,i n the

hands ofsome,proved ofgreat benefi t in th e treat

150

ment ofth is d isease, while others claim to havebetter success in the use ofchlorine water. O thersagain trust to quinine and iron internally

,and local

appl ications ofsulphate of iron and carbol ic acidas a wash to the throat

,or chlorate Of potash and

tincture Of iron . Two cases ofascites successfullytreated by inj ection ofiodine

,were reported by Dr

Ford,Of Norwood . Th is plan oftreatment is n o t

wholly new to the profession,but is deserving ofa

pass ing notice . Ithas been u sedwith success in some

cases ofovarian cysts.Hypodermic med ication has also rece ived i 'i

creased attention during the past year,

among the agents used hypoderm ically chloroformmay be mentioned . Some cases ofinveterate sciation wh ich had res isted all th e usual remed ie swere rel ieved by deep inj ections of from 20 to

40 drops ofchloroform in the buttock near thesciatic nerve. In some instances a single inj ectionsufficed to produce a cure . I ts use was occas ional ly followed by temporary anaesthesia ofthe leg ,but no other unpleasant effects were observed . I t

was tried in one or two cases in the To rontoGeneral Hospital with partial benefit to the patien tErgot or ergotine has been used extens ive ly in

an t l

uterine fibro id s,hemoptysis

,hematemes is, en larged '

spleen,and in purpura hzem orrhagica, with mo s tfavourable resul ts ; al so ammonia in collapse, and

woorara in tetanus. A report offifteen cases ofOf tetanus treated by hypodermic inj ect ions ofwoorara is given in S c/zm i dt ’s 7 a/zr lraclzer ,

-Ofthese

two cases Of rheumatic tetanus and seven out ofthirteen cases of traumatic tetanus recovered .

The use ofgalvan ism has been largely extended.

I t has been appl ied to the treatment of ovariancysts

,hydrocele , tumors and naevi . In the We/rzer

M ed . P resse three cases of ovarian cysts were re

ported cured by galvano-puncture after a treatmen t

offrom two to six weeks ; no unpleasant con se

quen ces ensued and none Of the cysts refil led . Dr.

Cutter,of Cambridge

,Mass

,also reports three

cases i n wh ich he employed i t but says i ts use isnot unattended with danger, and great care mustbe exercised in regard to the needles

,wh ich should

be insulated . Hydrocele has also been rap idly andpermanently cured by the introduct ion oftheneedles into the sac

,and Dr. Beard

,ofNew York

reports four cases Of naevus successfully removed

by electrolysis

Among some of the advances in surgery may

THE CANADA LANCET.

be m entioned the suspension Of the body and th eapplicationOf “the plaster-of-Paris ja'ck '

et In curvature ofth e spine. This treatment was introduced

by Professor Sayre ofNew York and has been triedin a large number of cases wi th satisfactory resul ts.Dr. Sayre has

,

been ia ngland dur ing the pastsummer, and has had abundant opportunity for

demonstrating his method Oftreating diseases ofthe spine. He was everywhere cord ially received,and large numbers attended his lectures and w i tn e ssed his demonstrations . His method of treat

ment received the endorsation of the surgical section ofthe British Medical Association . Esmarch ’s

bandage stil l continues to be used in certain cases,

though not so general ly as formerly. I t has lost

favor in amputation,owing to frequen t excessive

capi l lary hemorrhage after i ts u se. I ts value hasbeenfurther tested in the treatment of aneurism .

A case of popl iteal aneurism is reported in theLANC ET as having been cured by the appl icationof Esmarch ’s bandage for fifty minutes. -The treat

ment ofacute orch itis by ~puncturing the test icle,attracted considerable attention . In cases in

wh ich i t has been tried,it afforded immediate rel ief

to the pain and dim inution of the hardness. I t

is done by means of a grooved needle which i sthrus t in to the testicl e

,and a li ttl e serous flu id

allowed to escape . The relief is instantaneous andpermanent. Three cases ofextirpation '

ofthe rectumfor epithel ioma are recorded during the year ;one each by Drs . B riddon and Wood ofNew York,and on e by Dr. Agnew OfPhiladelph ia. One patientrecovered and two d ied . The diseased part is re

moved by making an i ncision around - the anus,dissecting away the d iseased rectum and after

wards bringing the bowel down and sti tching i tto the integument. Another Operation for the re

moval of the spleen has been performed by B ill roth ,but the patient died from hemorrhage in four hours

afterwards . A successful case of removal ofthek idney from a ch ild two years ofage, by Dr. Jessopof Leeds

,has been reported in th e LANC ET.

The child was do ing w ell at las t reports . A

new treatment for the cure Of p i les has been successfully employed during the past year. I t con

sists in puncturing them w i th the actual cauteryafter they have been drawn well down . They are

then returned and morphia administered for four

or five days,after which an inj ection or laxative

is used. The scars heal rap idly,and the patients

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152 THE CANADA LANCET.

d oes not interfere w i th d igestion nor produce cons tipation . I t is read ily assimilated and has beens uccessfully employed in all cases in which iron is

indicated. Ir has also proved ofgreat value as anantidote in cases of poisoning from arsenious acid .

Lactopept ine is a most important preparation , latelyin troduced to th e notice ofthe . profess ion . I t

c ontains the active agents of digestion,and has

been endorsed by the leading practi tioners i n theUnited States and Great Britain as . a valuable

remedy in those diseases of the stomach in whichi ts use is ind icated. Digestine is th e active prin

ciple Obtained from . the giz zard ofthe fowl,and

has been successfully used in the vomiting Ofpregnancy and as an aid to digestion . I t is claimed

to be much superior to pepsine, and invaluable inchronic vomiting not due to organic disease .Vaseline has lately acquired a special reputationas a dressingfor burns and scalds . The unfortunate sufferers by the late acc ident in New York ,had their burns dressed with this substance immediately on their admis sion to the Hospital.

Early in the year great dissatisfaction was fel t atthe action ofthe Imperial Board ofTrade in excluding Canadian surgeons from serving on board

the Allan steamers. After remonstrances from the

Dominion Government , and the medical schools

the Obnoxiou s resolution was rescinded. TheB ri tish Medical Council also took up the matter at

i ts meeting and recommended that all holders OfColonial qualifications should be entitled to registerin th e Un i ted Kingdom , but in a seperate alpha

betically arranged section ofthe register. The

s everal meetings ofthe professional body polit ic indifferent parts of the world during the year weremore than usually well represented. The AmericanMedical Association met in Chicago in the monthOf June and was largely attended. D r. Bowditch

the president del ivered the annual address , in wh ich

he dwelt among other things,upon the proposed

amalgamation with the Canadian Medical Asso

c iation . I t was however decided to continue thesystem of delegates as at present. Drs. Hingston,Grant and Buck

,were present as delegates from

Canada,and were cordially rece ived. The chief

points Of discussion at the meeting were concerningextirpation Of the uterus

,plaster ofparis bandages

in fractures,shortening in fracture ofthe , _thigh, and

plaster Of paris jacket in curvature of the spine.

Dr. Kimball detailed 1 3 cases ofextirpation of the

uterus,6 ofwhich

Hamilton and others

paris in the treatmentby Dr. Hingston was

shortening in fractureoccurrence no twi thstament ofth eDr. R ichard

for the next year, and Buffalo was named anext place, ofmeeting

, on the first Tuesday in1 878. The meeting Of the Briti sh Medicalciat ion was also a very successful gathering.

annual address was del ivered by Dr. R oberthe contagium vivum theory

,

his belief,that bacteria were

decomposition , and that theirair or water. Sin the surgicalp resen t. Both

the meeting were as usual,highly entertaining.

The Canada Medical Association pres ided over by

Dr. H ingston h eld its ‘

annual meeting in Montreal

in September, and was, from a scien tific point, themost successful ever held

,nor was the social ele

ment in any degree lacking. Dr. Lyon Playfair,C . B . and Dr. Taylor of Ed inburgh were presentalso Drs. Kimbal l and Brodie

,as delegates from

the American Medical Association . The proceedings and papers have been published in the Trans

actions, and may be Obtained by a ppl icat i on toDr. Osler

,Montreal. Dr. Workman was chosen

president, and the next meeting was appointed to

take place in Hamilton on the second WednesdayofSeptember 1 878 .

Many ofour medical brethren in this‘country

and in Great Britain , ever ready to alleviate suffering human i ty in whatever form

,have undertaken

the uninviting ta~k ofgiving surgical assistance tothe wounded in the Turko-R ussian war. They haven ot

,been very cord ially received by the inhuman

Turks, and have actually been forbidden in several

instances to perform operations n ecessary to savethe l ives ofthe unfortunate soldiers. The English

aid societies have actually to compel them to re

ceive helpfor the sick and wounded. The supplyofsurgeons is totally inadequate

,and there is room

for many more who may feel disposed to undertakethe duties .

In England the Penge case has been the subjectof much discussion among the medical profession .

THE CANADA LANCET.

Claire,Que Beaubien and Germain , O ttawa

Henderson , Bellevil le ; Betts , Kingston Spar

ham,Kemptville Aishton , Bath , &c.

, &c.

en signed by We conclude by wish ing al l our readers a happy

dred medical men to the new year, a long life of usefulness, and many happy

ion the post mortem appear returns Of the season .

Harriet Staunton were not

j us tify the conclusion that death was“i tam ‘ion Or anli

O the’,

f°rm ofmu?“

POSTMOR TEMS IN CR IMINAL CASES .

fai lure of the med i cal ev idence i n th i s

d to a consideration ofthe propriety ofmedical men noted for their experience

post-mortem appearances,to be

terest may be

the procuring from the Local Legis

Act ofIncorporation for Trinity Mediits subsequen t affi l iation with TorontoTrinity University

,and the Universi ty

th e ill egal exclusion ofth e represen

the Medical Council,and

legal process .’

In regard

Geikie, is should be stated

nd respectable minority of

very much disapproved of

vols. vi i . x i. xi i . xv. and xvi ;Durkee on Venereal Dis

5 by Duhring ; Carpenter’s

on Coughs, Consumption

on Therapeutics ; R eference

Loomis on Fevers Biddle’s

81 C .

ur fraternity who have passedand full ofhonors , we mayrgu son and Somervill e Scott

Caz enave OfParis ; Drs . Goruek

, Martin Paine and Crosby, of New

Paul F. Eve,of Nashvil le ; Nathan R .

ofBal t imore Sager,of Detroi t

,and many

Among those ofour brethren in Canadadeath it becomes our painful duty to

Dundas ; Dewar,or, London ; McC oll, Wallace

and Hornby,Toronto ; Cline,

Carpenter, Montreal Padfield,

Amherst, N.S . Johnston,Pic

Lancaster, N.B . Fores t,St.

When writing on the Penge case last month , we

overlooked the fact that Dr. Howard ofMontreal ,at the meeting of th e Canada Medical Associati on

last September,made a motion similar in substance

to the suggestion contained in the close ofour remarks

,v i z : “ That i t i s in the interest ofj ustice

that when post mortem examinations are to be

made,experts fam il iar wi th such scientific work ,

should be employed by the Crown when procura~

ble .

” As we before said, there are such men to be

found in the larger towns attached to the medical

schools,engaged in teaching th is branch ofprofes

s ional educat ion , who for that oreasoii enj oy exceptional facili ties for familiari ty w ith

‘

pathological ap

pearances , and i t would be wel l that coroners

should have the power Ofcal l ing in their assis tancein al l cases where inquiry is to be made into the

cau ses ofa death occurring under susp i c i ous circum stances .

I t has been suggested that an improvement in

the existing way of performing post mortems might

be effected by following the German practice of'i ssuing definite ru les to the coroners indicating the

mode in which the work is to be done, what parts

are to be examined, and the order in wh ich the

report i s to be drawn up . This would doubtlessact well in ensuring thorough examination , as the

requiring Of a report on th e condition Of each organ

would preven t th e poss ibi l i ty Of a morbid condition

in any one being overlooked , and so far it would

be useful .

I t i s also gratifying to know that greater atten

tion i s being paid to pathological teach ing in the

medical schools in Canada than was formerly the

case . Care is now being taken in instructing theclasses in the performance ofautopsies

,and in

directing their atten tion to the appearances of

diseased organs,and the teachers in al l the schools

on th is branch , we bel ieve, util iz e to the u tmost

the material at their command . This doesjnot,

154

however,meet the fact that the majority ofmedical

m en are not called on more than once or twice,in

the course ofa long practice,to perform post

mortems in cases that are afterwards to be the

s ubj ects Of j udic ial enquiry, and private postmortem s are almost equally rare . The whole

t ime ofthe medical practitioner is taken up withthe requirements ofhis practice

,and he has , too

often , but l ittle leisure or incl ination to keep uphis acquaintance with pathological appearances

where the diffi culties ofdoing so are as great asthey commonly are. However well grounded on

the subj ect he may be at the outset ofh is professional career, as other subj ects ofgreater. immediate importance fi l l h is mind

,h is ideas on

this become more hazy and uncertain as timeadvances.

We hOpe that this subj ect wil l not be allowed

to drop,but that

,as the Penge case is almost

c ertain to resul t in legislative action regarding thec onduct Of post -mortem s in criminal cases inEngland

, so we in Canada may take warn ing by

it to remove as’

far as.poss ible th e element ofdoubtas to the cause of death in such cases , by

.

appro

priate legal enactment on our] part, and we have

a lready indicated the course we think such action

s hould take .

SULPHATE OF CINCHONIDIA.

In view of thefact of the continued high priceofquinine and the intrinsic value ofsulphate ofc inchonidia in itself

,and as a substitu te for

quin ine, we desire to cal l th e attention of the profess ion in Canada to its valuable properties . Sul

p hate ofcinchonid ia is n ot a n ew remedy, but is

on e whose value is not as well known and recog

n iz ed as its merits would entitle i t to be. In fact

.i t is only within the past few months that i t has

been more than casually brought under the notice.of-the profess ion . I t has now had a fair and

impartial trial, and the verdict has been almost(unan imous in its favour. I t is not too much to.claim that i t possesses tonic

,febrifuge and anti

ip eriod ic :properties , almost equal to quinine. I t

has been used wi th complete success to cu t shortintermi ttent fevers

,to dispel the malarial com

plicat ions that somet imes complicate pneumonia,and to lower the temperature in acute rheumatism.

THE CANADA LANCET.

Sulphate Of c inchonidia is a most beautifu lpreparat ion . We have a sample before us manu

factured by Powers Weightman of Philadelphia,which it would be difficul t to distingu ish fromquinine . Some time ago the Madras Governmentappointed a commission to test th e respectiveeffi cacy ofthe different alkalOid s ofcinchona inthe tr eatment ofmalarial fevers. From th is reporti t appeared that there were fewer failuresfrom theuse of cinchon ine and cinchonidine than anyother Of the alkalo ids

,and the Government

has Offi cially advised the more free use in

India of these alkaloids,and especially sulphate

large doses,or th e long continued use ofquin ine .

The price ofsulphate ofcinchonidia, which isabout one-th ird that ofquinine

,is Of i tsel f an

item worthy of the serious consideration oftheprofession

,especially when added to the fact that

i t is almost,i f not entirely

,equal in value as a

remedial agent. This is a matter Of considerablemoment

,especially to country practitioners, who

have to supply their own medicines at great ex

pense annually,not only to the wealthy bu t to the

ind igent from whom they never expect to receivea single farthing for their services or med icines .We would never advise the u se ofcheaper medicines from mere mercenary motives. No on e

could conscientiously do so,but when we find

them equal in therapeutic value,and less expens ive,

we feel it our duty to recommend them . I t hasbeen asserted by some who have never given it a

fair test,that it takes three times as much cin

chon id ia to produce th e same effects as a givenquanti ty Ofquinine . This is not tru e , as may be

found by experiment. The majority Ofobserversagree in the s tatement that the quantity used issl igh tly in excess of the quantity of qu inine which

would be requ ired in any given case,and that

neither th e headache,ringing in the ears, sensation

offullness in the head, nor the suffusion ofth eeyes

,i s so great as when quinine is used. In a

number ofcases ofintermittent fever, treated s ideby side with quinine and cinchonidia in the Louis

ville Hospital,the latter gave the most satisfactory

results

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15 6 THE CANADA LANCET.

Times év G az ette) , has been using chrysophanic been given . Essays were

ac id recently with great success in the treatment parts of the country,and

ofpsoriasis . I t is used in the proportion of half a Atlantic. The next priz e, amounting to $4drachm to th e ounce of lard and appl ied as an wil l be g iven for the best essay received ono intment. This substance has succeeded after before the I S t OfFebruary

,1 880 . Essays sho

failure ofvarious other remedies . be forwarded to the resident physician,

chusetts General Hospital , Boston , on or

TR IN ITY MED IC AL S C HOOL R EPRES ENTATIVE that date .IN THE MED IC AL COUN C IL — After considerable

delay and much vexatious opposi tion,the l egal

counsel on both s ides have agreed that Dr. Geikieis the legal representative of Trin i ty Medical Schooland is entitled to his seat

,and that the costs

which have been incurred by reason ofhis,

il legal

exclus ion , shall be paid by the Med ical Council .This i s what comes ofthe attempt

,on the part of

a few interested individuals in the Council, to

exclude the legally elected representative of thelargest medical school in Ontario . An act i onfordamages wil l now be in order.DEATH FROM ETHER INHALATION — Several

cases ofdeath from the inhalation ofether haveoccurred lately. Two cases are reported in theB r i t. Med . y oum a! of recent dates. In one ofthese cases n itrous oxide gas was g i ven with theether, and in the other chloroform was first given

and afterwards ether— to the extent oftwo ounces .Another case is reported in the M ed . Times

G az effe, in which after ether had been given to

complete anaesthesia and the operation abou t to becommenced, the patien t became faint, and thebreath ing was suddenly arrested. All attempts

'

at

resuscitation w ere unsuccessful . A case is al soreported in the Va . Med . Mon t/l l) »somewhat similar to the foregoing

,except that resuscitation from

the primary effects of the ether took place and theoperat ion was completed

,but in afew minutes the

patien t vomited and immediately sank.

THE WARREN TR IENN IAL PR IZE — The Warren

priz e committee, consisting of the visi ting phys icians and surgeons ofthe Massachusetts GeneralHospital , have awarded the priz e ofthe presen tyear,

‘

to E. O . S hakspeare, M .D., ofPhiladelphia

,

for’

an essay On the Healing of Arteries afterLigation . The committee al so announce that thesubj ect for 1 880 wil l be Original Observations inPhysiology, Surgery, and Pathological Anatomy.

The obj ect of the priz e is to s timulate original

researches . This is the second priz e which has

OVAR IAN CY ST C OMPLIC ATED WITH PREG— Dr. Erskine Mason reports (New Yorklogical Society) a case ofovarian cystnancy combined

,th e latter

diagnosed unti l the trocaruterus during the operatio

wound in the uterus wasby si lver wire sutures .

the left ovary, but wasin the abdomen was closed. The

restless nigh t, and the following morning gave bto two foetuses of 5 or 6 months, after whichsank rap idly and died I 8% hours after

operation .

LARGE DOS ES OFIPEC AC . IN DYS ENTERY.Sprague ofStirling, Ont., wri tes in reference toarticle on ipecac . in dysentery

,in the S eptemb

number of the LANC ET. In 1 8 73 , during an epiderrof dysentery in Iowa

, he treated over I 5 or 20 cas

with large doses ofipecac— giving generallyadul ts hal f a drachm

,but before adrii in istering i t I

always gave 20 drops oflaudanum and appliedmustard bl is ter over the epigastrum . In mai

vases h e noticed sligh t nausea, but no emesishe has tried the remedy mentioned in many cas

s ince and has seen i t prove equally success iwhen tried by other physicians. He says he h

every reason to consider i t a specific. I t originatenot with him to verify i ts effi cacy

,as Fl in t in h

work alludes to i t,and the U S . Dispensatory h igh

endorses it , but unless i t is used as above d escrib<i t will disappoint many.

C 0MMU TATION R ATEs .—For the present year v

wil l supply the CANADA LANC ET with any of tlfollowing periodicals for the amount set after cacrespectively — With Braithwaite ’s R etrospect,New York Medical Journal

,Philadelph

Medical Times,

London Lancet R eprir

Dominion Monthly,

Scribnei

Monthly, St. Nicholas,

Appletor

THE CANADA LANCET.

Popular Science Monthly,Monthly

,Weekly

,or Baz aar,

I llustrated News , Estimates for

j ournal s wi l l be given if requi red. The

f subscri p t ion in advance, must in al1

pany th e order.

AC ID IN AC UTE R HEUMATI SM (T/ze—Dr. Wh ipham reports

ng case ofacutet is and bron

once , when

was apparently dying, by salicylate ofer failure ofa fair trial ofth e alkal ineThe remedy was given in twenty-grain

two or three hours — M ed . Times

FROM CHLOROFORM .—Another death

took place at Ancaster, Ont. , aThe patien t

,an elderly larty, was

0 an operation for the removal of

axil la. Only a small quanti ty ofbeen given when she suddenly

generation of the h eart was d is

post- 711071 2711.

"The medical men

R ES ORTS .

On th e globe is the

use ofAncomarco in Peru , at nearly 1 6,

‘

above the level ofthe sea . This and

gh level s, according to the authority of'

Webster,are particularly favourable to

sufifer ing from consumption,as Colorada

d , where alti tudesattained ; but the

her elevated posi

S ION .—The

the United States of America

00 graduates every year. Add

produce ofthe European andand we have an army ofnoannually added to an already

APPO INTMENTS .-John Gi ll ies , M .D . , ofTees

water, to be an Associate Coronerfor the Co .

Bruce.

W. A. Comfort, M .D .,ofCampden

,to be an

Associate Coroner for the Co. Lincoln .

J . W. Alway, M .D . , ofGrimsby, to be an Associate Coroner for the C O . Lincoln .

£ 00115 mi tt Qamphteta.

A GUIDE TO THE EXAMINATIONS AT THE R OYALCOLLEGE OFSURGEONS OFENGLAND

,by J .

Gant, Third Edition . LondonBailliere, Tindall 81 Cox, King Will iam Street .

This comprehensive l i ttle work contains information which will be found invaluable to those

who purpose presenting themselves for examinat ion

at the R oyal College ofSurgeons. The work i s

well known and highly priz ed in England by the

students, many of whom have to thank Mr.Gan t

for the success they attained at their examination.

LEC TURES ON FEVERS , by Alfred L. Loomis, A.M.,

M .D ., Professor of Pathology, &C . ,

in theUniversity ofNew York , pp . 362 . Wm

.Wood

Co . Toronto Hart 8 : R awlinson .

The lectures which comprise this volume,thirty

in number, were del ivered to the class in 1 8 7 6-7 ,and phonographical ly reported by Dr. W. M .

Car

pen ter. The author has adopted an etio logical

basis in the classification offevers,and has

endeavoured to include in a few general classes

all the n i imerous types described by differentwriters . The work may be said to contain asummary ofth e l iterature offevers in this country

,

and such foreign l iterature as is of interes t to the

profession . All the fevers inciden t to th is cl imateare treated of

,also the excan thematous fevers

smal l-pox , scarlatina and meas les. The work is

thoroughly practical in its character,and will be a

welcome addition to the practitioner’s l ibrary.

COMPEND IUM OFH I STOLOGY,by Prof

. Hein richFrey, and translated from the German by G. R .

Cutter, M .D . , New York . Illustrated with 208engravings on wood . New York : G . P.

Putnam

’

s, Sons. Toronto Will ing and Wil l iamson.

The science of histology has made rapid strides

wi th in th e past decade and has become an integral

part ofmedical studies, but the text-books on thissubject are so voluminous that we feel assured

15 8 THE CANADA LANCET.

th is compend will be gladly welcomed by students

and practicing . physician s . I t consists of24 lectures in which are embodied all the recent advances

in this department. The translator has done hiswork wel l

,and the typography and fin ish of the

‘ book leave nothing to be desired . With the

except ion ofthe introductory pages, which containa few rhetorical flourishes

,the author has confined

himself closely to the subj ect in hand.

MATER IA MED I CAFO R THE U SE OFSTUDENTS,by

Prof. J . B . B iddle , M .D ., J efferson Med icalCollege. Eighth ed ition

,revised and enlarged .

I llustrated . Ph i ladelphia : Lindsay BlakistonToronto Wil l ing and Will iamson .

The fact ofth is popular l i ttle compendiumhav ing gone through seven editions within a fewyears

,speaks more flatteringly than any words we

can ofier. The n ew edition has been carefullyrevised

,and in some parts re-written

,and contains

dress dcli val l the impo rtant new addi t i ons to materi a med i ca Congress in 1 8an d pharmacology. The au thor has succeeded in Boston Little

,Brown Co .

presenting a succinct account ofall the remed iesin use in this country, and the work will be foundofespecial value to med ical students

,to whom i t

i s ded icated.

HYGIENE IN AMER I CA— being the Centennial

A PRAC TIC AL TREATI S E ON THE ANATOMY, PHYS IOLO G Y AND D I S EAS ES OFTHE BAR

,for the

use ofmedical students and pract itioners,by

Chas . H . Burnett. A.M . , M .D ., Ear Infirmary.

Ph i ladelphia : H ,C . Lea. Toronto Wil l ing 8:

W i l l iamson .

game, Warrtagra, Quinta.The authorfi rs t describes the .

method of exam if l h

dii

s

tl

zge: oi'l

tiizfaniil ci in eafiriiiiimiiinifiiltlse :sgmthe On the 1 8th Dec ., R . A. Al exander, M'D"e y p er

Grimsby, to Sarah Harriet, elder daughterWhnal ear,and t e appropr iate treatment i n each case .

Alfred Booker,Esq .

,Montreal .

Part I is devoted to the anatomy of the ear,

At Alb'

th th D H A Bi on , on e 1 9 ec.,

onnaPart I I to the diseases and treatmen t.MThe work contains about 600 pages

,and is go t

‘D" Of Chesley, to M IS S Magg i e

,daughter

Alexander MunS Ie, Esq.

, ofAlbion.up in the very best styl e of Lea’s publ icat ions. I ti s wel l i l lus trated with wood-cu t engravings, and i squite an accession to practical medical l iterature . At St Claire Que Dr Wm Forres t on th7 ‘

y

I t wal l be

(

fi

ound o

c

fI

Interes t to the spec i al i st as wel lr oth of Nov.

,in the 74th year of h is age.

stu nt n ract i t ion er.as t e e a pAt Montreal , on th e 1 3th Dec.

,Dr. W. P. Sm i tl

OUTL INES OFMODERN ORGAN IC CHEM I STRY by in the 6 7 th year Of h is age.Prof. C . G. Wheeler, M .D .

, Un i vers i ty of At Bath, Ont . , on the 4th of December, ‘

r87 7Chicago. P rlce $ I -7 5~ Toronto 1 W i ll ing Dr. Ai shton , in the 7 7th year of h is acre.Wi l l i amson .

D

This work has been prepared w i th spec ial re T/ze c/zargefor n ot ice ofB iff/2.9, Mar r iages an d D eathis fifty t e n/s

, w /zz’

cfi sbou ld befon varded i n postage slump .ference to th e requ i rements ofmed i c al students . m y, ”ww flfi fl u n im tzbm

I t wil l be found to meet the requ irements of

teaeher and student , and to be whollyits methods and theory, as well as wholpresen t in i ts scientific data. I t has a

dex, i n connection with which ‘the

weights and formulae ofthe variousare given . The typographical exwork is excel lent .

The following popular magaz ines have also

received z— Scribner ’s Monthly for January,

also St. Nicholas Monthly for ch i ldren . Thin er is clubbed with the LAN C ET forthe latterfor per annum . Appleton ’snal and Popular Science Monthly for Janu1 8 78 . The former wil l be supplied with

LANC ET for and the latter forannum .

TRAN SAC TIONS OFTHE INTERNATIONAL MED ICONGRES S , PH ILADELAH IA, 1 8 76 . Editedthe congress by John Ashurst

, Jr . , A. M . M .

THE SPAS OFAi x-LEs-BAINS AND MAR LIoSAVOY : Their physiologi cal action

,modes

appl ication , cl inical effects, &C .

,by F. Bertie

M .D . Paris. London J . A. Churchill.

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160 THE CANADA LANCET.

possessing the power ofproteolytic action . Thepancreatic secretion is now known to have the

power of acting on the three chief groups of or

ganie constituents of food : th e proteids,the

starches,and the fats ; brought abou t by three

distinct ferments one proteolytic, through which

proteids are converted into peptones one amylol itic

,l ike ptyal in

,and a third wh ich has the power

ofconverting or decomposingfats i nto fatty acidsand glycer ine. To Corvisart, i s so far due our

knowledge ofth is proteolytic action of the pancreas.Kuhne however has very recently pointed out by

elaborate investigations that not only are the cond ition s ofthe ferment different from th ose ofpeps ine but the results l ikewise differ very considerably. Heidenhain has demonstrated that in the

pancreas, sal ivary glands, and stomach , there arestructural difference s to be observed which correspond with the various states O i functional activ i tyofth ese organs . He has pointed out that the

secretory cells ofthe pancreas do not contain readyformed ferment

,at the time of secretion

,but a body

which yields the ferment and which he terms

Zymogm fermen t generator. To these,the addi

tional discoveries ofKuhne, th row great l igh t noton ly on the function of the pancreas, but also on

the relations of gastric j uice ; pancreatic j uiceand bil e. He terms the proteolytic ferment ofthe pancreas ti p/ps i”, from its breaking up propen

s i ty, or dispos i tion . Trypsin cannot d igest pepsine

,but pepsine wil l destroy trypsin when in

acid solutions. How interesting is the part that

the bil e plays,first bringing peptic digestion to a

close,and then assi sting in pancreatic d igestion

at the very time, when such is required .

Claude Bernard has also pointed out in the intes

tinal j u ice, that the ferment which has long beenknown to exist, in thi s secretion , i s [ fi ver /231gferment,by which starches,proteid s and sugars are modified.

I might here advert to the fact that Dr. HerbertWatney is ofopinion that fat enters the system

,

when emuls ioniz ed, through the intercellular substance ofthe epi thelium covering the vill i. We

may well express, ‘

we grow fat ; but how ? Thenext interesting d iscovery made in

‘

physiology, towhich I desire to direct your attention , is that of“ Vis ion Purple.

” In November las t, Professor Du

Bois R eymond presented a paper from Dr. Boll , ofR ome, to the Berl in Academy, in whicn a new fact

ofcon siderable significance was s et forth, viz :

the ligh t wh ich penetrates the eye.” He has

pointed out that the red coloration,seen at

fundus ofthe eye by the ophthalmoscope,i s

_

the resul t ofthe l igh ting up or illum ination ofchoroidal vessels, but the true colour of

retina. This latter statement has since been m

consideration ,of many new

He found that the beaut iful pu rple colour persis tsafter death , if the retina is not exposed to ligh t.

Under the influence ofmonochromatic sodiumlight

,the purple colour does not disappear sooner

than from 24 to 28 hours. Accord ing to Kuhne,

as long as the epithelium ofth e retina is al ive, i t possesses the power ofrestoring the faded vision-purpl e .

Thus we have the epithelial layer ofthe retina performing a particular and importan t function , which ,to use the terms ofKuhne, becomes a purple generati r g gland. Many years ago, H enreich Muller

drew attention to the fact, that the rods ofthe frog’sretina are ofa red colour, from the imbibition ofred colouring matter ofthe blood. Leydig andMax Schul tz observed a like man ifestation in theretina of the owl and rat. These observations arestill in theirj nfancy, and before any certain datacan be arrived at

,will requ ire even closer investiga .

t ion . Kuhne states,that the cones ofthe retina

possess no purple col our in the frog. In the mon

key,thefovea cen tral l y i s destitute ofvision purple.

In snakes,the retina possesses only cones and no

rods,and is therefore destitu te ofvision purple.

These conclusions l ead to the idea that vision pur

ple is not essential to the perception of ligh t. In

these investigations it w il l be a source ofcongratulation if more accurate information can be obtained ,as to the manner in which various physical changesin the retina become the precursors ofluminousimpressions .Leaving now the changes of colour, I desire to

advert briefly to the recent investigations ofProfessor Tyndall

,at the R oyal Institute. I t is a

well-known fact that vegetable as wel l as animal

infusions, at a certain temperature, become turbidand ultimately lose their sweet smell. This

change is induced by swarms ofm inute organisms ,

THE CANADA LANCET.

and

latter

many months past Tyndall, has“ i nfective atmosphere.” His

greatly to s trengthen the idea

of putrefaction. Being unabl e

tory results in his laboratory in

wing to the impure condition of

erate ly prolonged

troy the power of

destroys only th e

When an infusion

it,no t from those

The germs ofwith th e adul t

forms or organ

of bacteria.

faction must, not be confounded with the germ

theory ofdisease : “The doctrine ofContagiumVivum ,

” as advocated by Dr. Wm . R oberts, of

Manchester, in h is address to the Bri tish MedicalAssociation. Dr. R oberts d irects attention to th eremarkable resemblance between a con tagious fever

and the action of yeast infermentation , or bacteriain decomposition . The various arguments adduced

,

and which have been so skilfully supported,are

now current in our medical j ournals . Dr. Beale,

ofLondon , in the Lum leian Lectures, for 1 876, says,The very last conclusion that would be adopted

by anyone who thoroughly though t over the matterwould be

,that thes e low organ isms are th e causes

of the changes in the fluids by which their growthwasformed, much less , that they were the cause ofth e diseases which had existed some t ime before

they began to multiply, in th e t issue and fluids of

the body.” He also poin ts ou t that the germs ofbacteria are to be found in every tissue and fluid

of the healthy body , ready to develope, under

favourable circumstances,in to countless numbers

According to Beale,heal thy t issue s

are an unsu itable soilfor septic bacteria.

” The

battl e now rests in such hands as those ofTyndall,

they take their 1 R oberts and Beale, and certainly recent inves tigaresu l t

ethod

adult

e substance is kept at a proper temperature,

le the indest ructible germs to arrive at asuffi ciently sensitive s tage of exis tence

,the substance

i s again subj ected to a mild heat. “ By this

method more is accompl ished,towards s teril iz ing

rated germs. Two

dea,that putrefaction

germ,exceedingly

process cannot,be

which air is pe rfectly

tion should enable the members of our professionto combat disease more successful ly, and while

the highest powers ofin tel lect are grappl ing withthose abstruse problems , l e t u s mos t earnes tly hope

that these marked scientific efforts may be theresul t of more accurate data

,as to the necessary

in i tial conditions ofdisease.While reflecting on the s tatement ofDr. Beale

,

That we find no traces ofbacteria in heal thyblood and healthy t issue

,

” le t u s consider briefly a

few facts on the disease termed by Biermer, of

Zurich,Progressive Pernicious Anemia.

” This

term itsel f has considerable sign ificance,and ye t

not sufficiently expl icit to define its precise meaning. Dr. Bramwel l, of Newcastle-ou-Tyne, describes this d i sease as a profound anemia

,which

i s associated with marked changes in the microscopical characters ofthe blood, and, in most caseswith the presence ofretinal hemorrhages.” Pro

found anemia is considered by careful observers acommon condition , and i s met wi th in all caseswhere there is great loss of blood, lymph , or anybdfthe secretions or excretions. Professor Eehh

’

efrsifi s ofOpinion that

'

progressive pern icioérsl eanehifd

162 THE CANADA LANCET.

can be determined by a microscopical examination

ofthe blood, but even th is statement requires stilla considerable degree ofobservation , prior to asatisfactory solution ofthe entire problem . Ac

cord ing to Bramwell (Med. Times,Sep . 1 87 7)

in ordinary cases ofanemia of sufficiently longduration

,alterations ofan analogous character

,

have been observed in the blood. Dr. Osler, of

Montreal , has also noted the very small cor

puscles upon which so much stress is placed , evenin heal thy blood. Their numerou s pre sence

,

however, he favors as l ikely connected with pernicious progressive anemia . In tracing the first ray

ofl igh t, which attracted attention in this peculiarcondition , appears according to M . Lapine

,to be

a_

case recorded by Andra] in his Medical Cl inique,

1 823 . I t is considered, that owing to the imper

feet report, i t may have been a case of Bright’s

Disease. Then follow two cases,reported by Bar

clay in th e Medical Times, 1 85 1 , described as

death from anemia. Strange i t is,that Dr. Ad

dison , of Guy’s , who so dist inguished himself in

kidney disease, should have been the.

firs t to giveforce and character to h is impressions on thisparticular form ofAnemia as and so

graph ically revived by Professsor Biermer, of

Zurich, as progress ive pernicious anemia.” See

report, by Drs. Bell and Osler, (Transactions Canada Medical Associations .) In 1 85 7 , Dr. Wilks

published ( in Guy’s Hosp ital R eports ) ninecases of fatal anem ia. In 1 863 , Dr. Habershon .

ofLondon , published a case in the Lancet, ofal ike character. Various other reports of cases inBrit ish and foreign j ournals

,amount to about 46

i n number. More recentlyappeared, the paper ofDr. Howard, ofMontreal

,in the transact ions of

the American Medical Association,at Phi ladel

ph ia also the admirable report ofDrs. Bell 8: Osler,on the same disease . I t appears to be connected

.with the pregnan t condition loss of blood evenmoderate in character ; and sl igh t continuous

d iarrhoea. The usual anatomical l es ions foundafter death are those incident to anaemia

,but in

addition , fatty degeneration , defined by Addison

as remarkable persistence of fat,in spite ofweak

ness and pallor. This condition has been moreparticularly noted by Lapine

,in

“

connection with

the heart. R ecent experiments lead to the beliefthat even fatty degeneration may (through ruptured and weakened vessel s) bring about the

caseeral well defined cases

throws some degree ofdoubtdiagnosis, from this point alone.with these microcytes

,nucleated

have been found in the blood.

function ofred marrow, as definedand Neuman— has given

vania,has described certa in abnormal appearan

in the marrow, on which he bases a theory asthe causation of this d isease. He considers

anemia ofAddison or Biermer,merely as

m edullary form of pseudo-l eukaemia.

” Thus

observe there is considerable diversity ofOpinieven on the pathological appearances of this

cu liar d isease. R ecently,he has endeavored to

trace a connection between Add ison’s d isease andchronic wasting, in which there are well -defi ned

evidences ofanaemia. These he has classed asanaematoses , contrary to the

'

opin ion ofDr. Greenhow,

who considers that the blood does not

undergo much C hange in uncomplicated cases ofAddison ’s d isease. Dr. Howard

,of Montreal

,in

his admirable paper,gives the following among h is

conclusions,that neither the spleen

,nor the lym

phatic glands usually present any,much less any

special les ion, in pern icious anaem ia. That i t rema ins to be proved that hyperplasia

,or other

change ofthe bone marrow is a cause of anaem ia .

How interesting becomes the fact, as to the re

markable s im ilarity between leucocythaemia in its

resul ts,and well defined anaemia. In th is part icu

lar also,arises a marked l ink of connection in

Hodgkin ’s disease,the anaemia ofwhich is dis

tingu ished from the progressive pern icious, by themarked lymphatic glandular enlargement. I haveonly briefly touched upon some interesting fea

tures ofthis disease, which is now occupying the

close observation ofable physiologists and pathologists

,and from the diversity of opinion, so far

expressed,we may well acknowledge the accuracy

ofthe remarks ofProfessor Qu incke, (Med. Times

Gaz ette,Oct. 1 4th ,

“ We have not to“ deal with a s ingle d iseased condition . Pem ic ion s anaemia— l ike anaemia, in general, is the

“ product ofextremely various morbid processes,

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l 64 THE CANADA LANC ET.

muscular system thus it not only is an instrument

Of the hemisphere, but is also intimately associated

with automatic act ion . The observations ofFerrier cover a wide range, and exhibit much labor

and research in clearing the path Of intellectualactivity. The nervous system occupies a place

and power in the animal creation ofvast importance , and notwithstanding the energy and skil l ofth e anatomist and phy siologist, we as yet only

appear to be approaching the data by which asolution may be given to a great mental problem.

NO sooner areFerrier’s Opinions expressed, thanEugene Dupuy, M .D ., ofParis , takes the initiativein expressing views considerably at variance withthose Ofhis able co-temporary. All h is p sycholo

gical deductions, I own , are based on physiologicalfac ts

,but these facts

,I have proved

,I trust, to

have been considered only in a one-sided way,viewed unequally, as the phrase goes.

” He cousi

ders there is a seeming concordance between the

theories of the advocates ofthe localization doc'trine, and th e deductions of Herbert Spencer,Professor Bain , and others who have been occupied

in the sam e l ine ofthought. Brain substance, and

in fact nerve tissue generally,are actively under

the consideration ofmany ofour master minds,and how gratifying will be the announcement that

th e much vexed question ; the influence of mind

over matter, has been settled and placed beyondthe reach Of Punch

,who asks “What is matter ?

Never mind. What is mind P That’s the matter.

The recent observations Of Mr. R omanes , at theR oyal Institute

, on“ The Evolution Of Nerves,

”

is ofmuch interest. He concludes,after important

anatomical research on the Medusae, or j elly fishes,which have the lowest form Of nervous system as

yet demonstrated, that th e conducting substance isintermed iate between nerve and muscle, a different iated “ line of discharge.” Should h is deductions

prove correct, the conclusion arrived at would be,that the l ink between ordinary contractile protoplasm and excitable nervous tissue

,has been dis

covered by Mr. R omanes,in those l ines ofdis

charge. The recent announcement by Professor

Englemann , Of Vienna, that h is exp eriments tendto confirm the views Of Hermann

,on the subject

the heart as a whole, but each individual muscl e

cell contained in the heart, whilst in an uninjuredstate,

'

and at rest, is almost or quite free from electrical currents. The point Ofgreatest importancein Englemann

’s researches

,i s the discovery Ofthe

very rapid diminution Ofthe el ectro motive forceOfthe current observed

,when a cross section

,

th rough the base ofth e ventricl e,i s connected

with one electrode, and the apex with th e other.This entire subj ect i s full of interest— and when

we consider the important place electricity now

occupies in the treatment Ofdisease— I am quite

satisfied it will receive at your hands well-merited

attention . On the present occasion , I have adverted briefly to afew topics, upon which somemaster-minds, well termed

“ great have very re

cently been occupied. Their observations and deductions have been the resul t ofuntiring z eal and

unrelaxing efforts. What means the term great ?What is i ts significance ? I t is that which credits

him with being supreme in h is particular depart

ment. Dante was an eminent poet,and Bacon

a distinguished philosopher,and so i s i t in th e

path s ofour noble profession . We may lose sigh tOfthe idea, but let us respect our calling

,and

while ch eri sh ing the memory of those whose vast

intellects have stamped the profession as one to berespected and honored, le t us pass l ightly over the

imperfections of any possessed ofless gifted qual ifications. Charity begins at home

,and a good

example is frequently productive Of a most salu

tary influence. Imagine th e vast labor devoted

to many researches to which I have briefly ad

verted. The nights Oftoil, th e restless hours, thepatient endeavours , the uncertainty ofsupport,and last

,altho ’ not leas t

,the antagonism ofequal

intellectual power,in an Opposite channel . Publ ic

Opinion is a lever,possessing great microscopic and

analytical acumen ; i ts ultimate dec is ions are seldom in error. In fact

,common sense, the very

foundation of practical experience, w il l solve th eproblem . In conclusion

,I am not unwilling to

acknowledge the fact that so great is the progressofour age

,in almost every department ofthough t

,

Of “ Muscular Current,is a source Of great inter that in the short space

,

ofa single l ife-time, th eest. Some years ago

,Hermann stated that

,in a highest degree ofin tellectual capacity will only

perfectly uninj ured,unskinned animal

,th e muscles enable the most constant worker to accompl ish a

which are i n a sta te ofrest,are entirely free from single atom in the scale ofhuman understanding.

THE CANADA LANCET.

DOSES OFACETATE OF LEAD IN POST PAR

TUM HE MOR R HAGE.

J . N EWELL, M. D L. R . C . P. 6: S ., S PR INGF I ELD,

ONT.

No . ofth e C ANADA LANC ET Ion the above subj ect, from the

practice

ave concluded it would

he resul t ofmy exper iemploymen t Ofacetate ofl ead inh emorrhage, and al though I have

few cases ofhaemorrhage occurringfrom the fact that I almost invariably

ose oflabor administer a ful l dose ofpart icular in keeping a firm

emptied uteru s, yet in some

haemorrhage Ofa very alarm

ene, and notably so in one

ich I shal l presently give,

make a d igression . I t is my

amongst accoucheurs, th e proper

and th e prevent ion ofexhaust ingin th e th ird stage Oflabor i s not sood and practi sed as i ts importance

have for some time past removed

is termed in that

Midwifery,

” with

fully satisfied that

the managemen t ofth e foregoing work will

gest as well as the Oldest

1 8 7 7 , I was summonedfi rs t confinement. The

and in abou t seven hours

appearance Of the patien t, and to such an extremedegree as I had never witnessed before. Immed iately divin ing the cause I grasped the now re

laxed uterus with my left hand,wh ilst I introduced

my righ t into the u terus , and by making both intem al and external manipulation

,endeavoured t

excite contraction , th e blood in th e meantime flowing in a perfect torrent. R ealiz ing that my patien t

would perish in a few minutes i f I did not arres tthe haemorrhage

,I calledfor my medicine case ,

and taking out a teaspoonful ofth e crystall iz edacetate Of lead (wh ich by the way I always takealong with me in such cases ) I ordered i t to bedissolved in some water

,and had it adm i nistered

to the patient at once,and at the same time had

‘an

ass is tant raise the foot Of the bed. The effect ofthe lead was I migh t almost say mag ical . The

flooding ceased at once, and in a very short t imethe uterus contracted , and expelled my hand, andI fel t assured that I had been

,through the admin

istration Of th e lead, the humble means ofsaving ahuman l ife. In a very short t ime

,and as soon as

the patien t was able to swallow, ( for when the hae

morrhage ceased she was lying insens ible), I ad

min istered a draught Of brandy and ammonia. I

then appl ied the binder with a compress underneath , and after giving some nourishment and ad

ministering an Opiate I waited for a couple Ofhours and went home. From this on , the patien tunder s timulants and nourishment, with an occa

sioual Opiate, made a rapid and satisfactory recov

ery. In this case I feel quite confident had I

trusted to ergot, with manipulation, cold, &c.,that

before contract ion became establ ished, my patien t

would have sunk, never to ral ly. I have tried the

lead in other cases ofpost partum haemorrhagewhen the flooding was not so profuse , as in the

one described , and I have always found i t effi cient

and rel iable , and have yet to see any il l effectsfrom the large dose s in which i t has been exh ibited.

Dr. W. in h is articl e says I was rather sur

prised,ifnot a l ittle mortified to find that in a

total Of perhaps one hundred and forty s tudents ofthe Toronto Medical Schools examined by me on

Obstetrics last April,only one gave amongst the

mul tifarious suppressors ofpost partumhaemorrhagethe exh ibition oflarge doses of acetate ofl ead .

”

I believe I can lay cl aim to the distinction Of beingthat person

,for although I was a graduate Of 1 8 7 1 ,

still I did no t pass the examination Of the Med ical

166

Counci l til l last April . I gave in my answer

rim a/1m doses ofacetate oflead as being a mosteffic ient suppressor Of u terine post partum haemorr

hage. The administration of large doses Ofacetate ofl ead is most strongly inculcated and ad

vocated by Prof. Lavell , ofKingston , as a potentmeans Of arresting post partum haemorrhage.I find that my paper has far outgrown the l imits

I had assigned to it , but if it only has the effect Ofi nfluencing my m edical confreres to try the ad

min istration Oflarge doses ofacetate ofl ead in thecases indicated

,I shall feel satisfied that my labor

has not been in va in,and that they will be amply

repaid with its resul ts.

A HANDY

BY S IMON F ITC H , M . D . ED IN .,HAL IFAX N . s .

This is an India-rubber apparatus,l ike a H ig

gin son or Davidson syringe , bu t with treole t/zz'

ok

ness ofall the walls,wh ich gives strong resil ience

and powerful suct ion to the bulb,and prevents the

poss ibil ity of Obstruction from col lapse Ofthe tubes .The aspirator—needle may be attached to eithertube , for exhaustion or inj ection , and i t may be

worked wi th one hand wh ile the needle i s insertedand steadied with Moot/ter .

A rep re sen ts the d ome asp i rator-nee dle , w i th the cu t t ing ~

poin t p ro

jected , readyfor pun cture ; G , a magn i fied d iag ram ofthe same ,

afte r in s e r t ion , w i th the dome ad vanced s o as to p rot ect the in t e r i or

ofthe cav i ty d u r ing asp i rat ion ; B , bu lb i n u p r igh t pos i t ion to i n

s u re the be s t act ion ofvalves ; C C ,valves ; D , en t rance

-tu be E,

e x i t-tube ;FF, b i ts Ofg lass tubing through w h ich to Obse rve the

p res ence or abs ence offlu id .

After the needle is introduced the bulb shouldbe held upright, or perpend icular, with the orifice

*Pub lished also in N. Y. Med ical Journal.

THE CANADA LANC ET.

d urreapuudmrr.

ACETATE OFLEAD IN POSTO

PAR TU M

H/EMOR R HAGE.

To th e Ed itor ofth e C ANADA LANCET

by which the fluid enters below ,and the orifice

exi t above the valves at these two orifices will fallexactly into place

,and regurgitation toward the

needle wil l be impossibl e. If the operation is to

test the existence Of fluid at uncertain depth s , th e

bulb may be tigh tly squeez ed till the point oftheneedle enters the surface ; then the pressure may

be relaxed,when the strong suction will discover

fluid instantly u pon the needle reaching i t. I f the

operation is to empty a cavity,as a bladder or

pleura,then

,after the current i s established , by

once or twice working. Of the bulb , the flow w il lcontinue Of itsel f

,from mere siphon—action without

further manipulation ofth e bulb ; but if, fromthe smallness ofthe needle, the stream seems sluggish

,i t may be quickened by working the bulb

occasionally or continuously.

I have used this apparatus in.hydrothorax and

empyema, and in exploration ofObscure abdominaland pelvic enlargements

,with great satisfaction ;

and,with the d’ome-l roear needles ofNo. 1 and NO .

4 siz es, i t i s available for all purposes ofaspiration,and especiallyfor cases requiring accurate stead iness Of the inserted needle , as in tapping the per

icard ium and the j oints ; for, as the whole affairis managed by the operator alone

,there will be

complete unison between the hand holding the

needle and the hand working the bulb . Messrs.

Tiemann make th e instrument exceedingly well,

with the dome needles as descri bed , and fi t i t into

a smal l case .

Sir;— I have now for some years withdrawn fromthe active pursui t Ofmy profession , except amongimmediate family connections and afew intimatepersonal friends

,but

,

“ Even in our ashes l ive their

wonted fires,

” and the January NO . ofyour jou rnalhaving been forwarded to me

,I was pleased to see

the article commun icated by Dr. J . Workman,on

the u se oflarge doses Ofacetate ofl ead,and

I beg to offer my corroboration Ofh is testimonyin i ts favor.Dr. W. is however sl ightly inaccurate as to dates.

I recol l ect al l the circumstances Of the case referredto ; i t was orchitis, and as I left Montreal in 1 82 7 ,

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“

168 TIIE

I wan t to say a few words to you with regard tothe symptoms and d iagnosis Ofheart d isease. Ourfi rs t duty when disease Of the heart is suspected isto exam ine both heart and lungs careful ly. Thetwo most constant symptoms ofheart disease areshortness ofbreath upon exertion

,and palp i tation .

There may be,in add it ion , dropsy, ep istaxis, and

cough,wi th spitt ing of blood.

F i rs t,as regards the dyspnoea. I t may be con

stant,and i t may only occur upon exertion . This

symptom is alw ays present in serious organic d isease Ofth e heart or lungs

,and is due to the im

pert -ct ox idation of the blood,owing ei ther to pas

sive congestion of the lungs from m i tral disease,

or to the fact that the action of the heart is sorap id that the blood has not t ime to be oxidiz edin its passage through the lungs. Palp itation

,j ust

l ike dyspnoea, may be constant , or only occas ionalin c ardiac diseases . I t may be caused ei ther bythe imperfect fill ing ofthe cavity Of the heart

,or

by the fact that the heart is always engorged andalways struggl ing to expel the blood . Wherethere is a nervous elemen t in the case the palpitation may be due to disturbance ofth e card iacp exus , or pos it ive degeneration Of those nervecentres . Dropsy is only present in the later s tagesOf heart d isease , and in most cases is due to a mechan ical damm ing back ofthe venous blood . Thi sO bstruction may be so great as to cause rupture ofth e wal ls ofth e veins

,and hemorrhage

,instead of

l eakage of serum .

In making a careful diagnosis ofheart diseaseyou must begin by examin ing the heart. Thus letme take Case 3 , for instance. I find sl ight fullnessOfthe praecord ia. The impulse is fel t as h igh upas the third rib

,as far down as the sixth

,and from

the edge ofthe sternum out to beyond the l ine ofthe , nipple. In this instance th e area of heartdullness is three inches up and down , and two ando n e-half inches transversely. The normal l im i tsOf dul lness are not so great. This tells me at oncethat someth ing must be wrong. Let me try auscu ltation

,as it is the mos t accurate physical

m ethod. I begin by l istening over'

the head Of«the th ird rib on the left, because that spot is closeto al l the valves ofthe heart. By l istening here Ican dist inguish a very marked murmur. (The Professor at th is point entered into a long descriptionOf the character ofthe two normal sounds. ) Inboth these cases (3 and 4) the murmur is synchrouons with the firs t sound ofthe heart.We have determined that there is a murmur, and

also that i t is synchronous with the firs t sound ofthe heart

,but the point now arises

,where is the

murmur produced Let us note in what directionthe murmur is best carried. This is always thed irection in which the blood is passing through thed iseased valve. In this case I cannot hear themurmur at al l at the aortic cartilage

,and but feebly

at the pulmonary cartilage. At the point ofthe

CANADA LANC ET.

GENER AL SUBINVOLUTION WITH PR O

LAPSUS OF THE UTER US AND VAGINA .

C L IN IC BY PROF. THOMAS , OFNEW YORK.

transmitted round under the left arm,and d ist inctly

heard at the lower and posterior angle of the leftscapula ( th is po int corresponds with the apex Ofthe heart in front) . Let us see

,now, where we

are. We have heard a strong,blowing, systol ic

murmur,which is synchronous with the first so und

ofthe heart, and is heard most d istinctly at thepoint at the heart

,and is transmitted round under

the left arm and heard at the posterior, inferiorangl e Ofthe left scapula. I t mus t be a m i tral r e

gargi z‘

an l . In the same way. I m ight go throughCases 1 and 2

,but I hope you have seen enough

to und erstand the method ofphysical diagnosis incases ofcard iac d iseases. At some future timeI shall have something to say to you about thetreatment Of these diseases. Merl .

and S m'

gz'

eal R epor ter .

Eliz a G .,a native Of Ireland, and th irty-nine

years ofage. She has been married sixteen years,and has had seven children, bu t no miscarriages.The last ch ild was born e igh t years ago, but she issti l l l iving with her husband. She says she hasbeen complain ing for three months past, but wasquite well before that. She first noticed a l i ttlelump in the righ t side, with pain, which

“ s truckupward ” over the hepatic region , and extended asfar as the head. She also complains Ofa weakness in the back

,

” and suffers from leucorrhoea attimes. Her menses are regular, and she never hasany trouble with the bladder. This is all she hasto tel l us

,and you will notice how very vague the

symptoms are. There is noth ing in them whateverto direct our attention to the uterus except thebackache and leucorrhoea but on account ofthese I though t i t was better to make an examination

,and when I tell you what I found I am sure

you will b e not a l ittle surprised to learn the gravityOf the affection here present when the symptomswere so trivial . This case shows very conclus ivelythe value ofphysical diagnosis, and any on e whohad not resorted to it here would probably havetreated the woman for disorder of her l iver. Icannot impress upon you too strongly the verygreat importance of phys ical explorat ion, not onlyin uterine but in al l other diseases. Well, on passing my finger in to the vagina (wh ich , by the way,I had some difficulty in do ing) , i t encountered thecervix

,very much enlarged

,within two inches

from i ts entrance. The reason that I had trouble

THE CANADA LANCET.

probe passes into i ts cavityches we j udge it to be in aFurthermore

, t he examinaS no perineum. NO cicatri

d we naturally ask what hasis i t has become completely

occurred,and i t is now dragging that organ d own

too, and will soon have i t out ofthe body. The

process ofretrograde metamorphosis after parturition was interfered with not only in the vagina anduterus but also in the perinaeum . The perinaeumalways undergoes a process ofpreparation and developmen t before labor, and it is j us t as necessarythat involution should take place in i t as i n theuterus and vagina. The difference between thecondition ofthe perinaeum at ordinary times andat the close ofpregnancy is very evidently shewnwhen we undertake to remove large fibroid s , perhapswith the obstetrical forceps

,as I have sometimes

done. In such cases the perinaeum invariably

t,which always aecompresent our patient is ain the th ird degree

,a

as these are difficul t to treat satisthe time ofth e menopause had arcount upon the entire disappearanceO lution ofthe uterus . But someelapse before that occurs, and I dosay that there are no means at ourreducing the organ to i ts normal

ALIMENTATION IN SU R GICAL ACCIDENTS AND DISEASES.

BY FRANK H . HAM ILTON, M.D.

are used upon the vagina. The proper pessary forthis case is one made ofhard rubber

,such as I

show you n ow, and consis ting of a cup, to rece ivethe hypertrophied cervix

,and a supporting stem

divided in to two branches,one ofwhich curves an

teriorly towards the symphysi s pubis, and the otherposter iorly towards the anus . From the extremityof each ofthese arms passes an India-rubber bandwhich is attached to an abdom inal belt

,and the u terus

suspended in th is way w i l l be able to res is t al l thedragging force that i s exerted upon it from below.

The great advantage Of th is instrument is that thepatient can apply it hersel f

,and i t should always

be removed at night. After a time there w i l l bealmost no tract ion to overcom e

,for the mere re

tain ing ofth e vagina in posi tion w il l gradually t e

move the engorgement now exis ting, and i ts wal l swill become more and more strengthened by thepersisten t use Ofthe astringent inj ections ofwh ichI spoke. I f th is plan oftreatm ent is adopted Ith ink I can show her to you very greatly improvedin th e course ofa very few months.The other plan to which I alluded is the Opera

tionfor the removal ofa portion Of both the an terior and posterior walls Of the vagina and the formation ofa fi rm ridge ofsupport in each . Th iswould prevent any future prolapse ofthe vaginabut not ofth e u terus.

44’ ~lf

Ifth e food is not appropriate, the patien t whoreceives i t wil l not only suffer from lack Ofnourishment

,but also from the irritation caused by the

presence Of undiges ted , and, consequently, i rritatingmaterials. S llffl altempz‘s at alimen lation w i ll eer

tai zzly increasefebr i le action aml aggr avate i nflammation .

The fact is,however, tha t examples are exceed

ingly rare in wh ich some feeble abil ity to diges tfood does no t exist and even in these exceptionalcases

,a j udicious selection and timely adm inistra

t ion ofcertain articles se ldom fails to produce anappetite

, or at all events to convey to the systemsome nutrit ion . A

_

warm, well seasoned and well

cooked cup ofbroth , or a fragran t cup ofhotcoffee and milk, will often rel ieve nausea andepigastric distress, assuage a col ic, diminish theseveri ty ofa headache, l ift the tone ofthe nervessuffering under shock ; and the same or s imilarmeans will often abate sens ibly febrile disturbanceand soften the pains Ofinflammation . Who everknew of harm from food under these circumstances

,

when carefully and j udiciously admin istered ? Iam

,at least, certain that for every case in wh ich

170 THE CANADA LANC ET.

i t can be shown to have done harm,twenty cases

wil l be found in wh ich i t has done good .

Medic ines— so-called— are in general so far i hferior to a fragran t and savory cup offood,as

peptic persuaders,and I have seen many patients

suffering with nausea and loss ofappet ite, who

have been speedi ly rel ieved by the mere omiss ionofth e bi tter and d isgusting ton ics wh ich have beenforced upon the ir reluctant stomachs . I t is truethat, und er the circumstances referred to, now and

then good med icines do good and improve theappeti te , and the ir occasional abuse or unsk il l fulexh ibi tion is no reason why they should n ever beu sed . Nevertheless

,I wish to say

,very emphati

cally,that the abuse ofmed icines is more than

occas ional .” I t is alarm ingly frequent. I t is asimple elementary truth

,that there are many d is

eases and surgical injuries in wh ich recovery takesplace as speed ily withou t med icines as w i th med icines an d if any med ical man has not learnedthis, an d continues to give drugs from day to dayfor every form and grade of human ailment

,so

much th e worse for h im and for h is patients .But if men can l ive and recover from disease

sometimes without medicine, no man can l ive or

recover from disease without food. Organs wh ichare maimed and struggling must have food

,or they

w il l soon cease to labor,and wi l l die. A wound

will not heal n or a bone un i te w ithou t nutriment.In every human malady and surgical accident

,

repa ir and recovery wai t on nutrit i on .

I t i s n ot improper, then , to say that as a meansofrestoring the sick and wounded

,when both may

be needed, good food is ofmore imp ortance thangoo d med icine . Large armies have always sufferedmore from a deficien t supply ofproper food thanfrom a deficien t supply ofproper med icines.One conclusion to wh ich my statement offacts

and process ofreason ing leads me is that hospi tal sand d ispensaries ought to have the means andappliances for supplying to the sick

,infirm

,and

maimed who come to them for help,no t only

m edic ines and skilled med ical and surgical services,

but also an abundance of nutri tious food ; indeed ,that th e question of food ought to be the first

,

where i t i s generally the last consideration .

Th ere is an impress ion among many laymen,

who have the charge ofhosp itals,that “ extras

,

”

includ ing eggs, m ilk , etc. with th e services ofthe“ diet k itchen ,” ought to be reserved for thefewwho are very seriously i l l , and that al l the slightly '

il l or con velcscen t should be content with the“o rdinary ” diet ofthe hosp ital

,wh ich i s .seldom

very attractive to even a sound stomach . Thosewho have had experience in th e United Statesarmy hosp itals know that th is was never the theoryor practice ofthese hospi tals bu t that all Of theregular ration s were commuted

,and with the

money thus obtained noth ing but what m ight beterm ed - .extras were purchased .

0

If a man is able to eat hard~tack and salt pork ,or tough beef and unsavory soups

,he is able,

generally,to go to work

,and ought not to remain

in th e hospital . Though well in other respects ,and detained only because h is broken l imb is notthoroughly repaired

,i t does not follow that he can

eat and digest what he could easily master whenworking ou t Of doors

,and carrying brick-hods to

the top offive story build ings . I f i t is an objectto get these men speed ily ou t ofthe hospital , andthus save the tax-payers if i t is desirable to restorethem soon to the ir famil ies

,ofwhom they may be

the sole support,then it wil l be necessary to give

them food which w i l l encourage an appet ite, andbe easi ly digested by a stomach weakened by longconfinement

,sickness

,and anxiety. They must be

treated in th is respect in the hospitals , as we —you

and I —are treated at home,where the utmost care

is taken to see that our food is su i table and ap

pet iz ing where,although we may have ceased to

take medicine,so long as we find ourselves unable

to return to our usual out-door duties , we are fedonly upon extras.” These same poor people,inmates ofthe hospitals , if they were at home, inthe ir own humble apartments, would be fed better,so far as the qual ity and mode ofpreparing thefood is concerned

,than they are in most public

hospitals. No pains are spared,generally, to fur

n ish the poor all the medicine they need ; butwhat they want most

,and get the least, i s good

food .

The medicines and liquors dispensed at BellevueHospi tal during th e six months ending July 1

,

1 87 7 , cost andfor all ,th e charities and

prisons under the charge of the Commissioners OfPubl ic Charit ies and Correction

,these two articles

cost,for the year 1 876 , about one-fourth

ofwh ich , th e apothecary informed me, was forliquors ; l eav ing a balance ofabout ashaving been expended for other med icines thanstimulating l iquors. Possibly a much larger sum

has been expended for extras in the same institu tion s . Upon th is point I am not informed , butmy long connection with this

,and other civil hos

p i tals, enabl es me to say that i t i s generally mored iffi cult to obtain proper food, and a supply sufficien t for the demand, than i t i s to obtain goodmed icines and in sufli cien t quant i ty.In these remarks there is no imputation upon

those excellen t and humane gentlemen who are incharge ofthese insti tutions. In my op in ion weare alone responsible for th is state offacts , inasmuch as we have h i therto failed to urge upon themand the pub lic the greater importance ofnutrimen tand the comparatively less importance of med icine.Some intel ligent men and women , not ofour

profess ion,have seen the want before we have ,

and they have establ ished in various parts oftheci ty diet kitchens, to supply the very want of wh ichI am speak ing

,and Wt h are properly made sub

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1 72

Forcible extension was now practiced underchloroform

,and was at tended by a recurrence of

the inflammation ; but th is was rapidly subdued bythe previous treatment . The final resul t was almostperfect cure the patien t could walk and move thej o int in all d irections without pain . The onlytrace Of the previous d isease wh ich remained wasa trifl ing amount ofswell ing , and a somewhat 1mpaired mobil ity ofthe articulation .

Dr. Cohn states that the l imb should be thoroughly emptied of blood

,and the occlusion Should

be a perfect on e. The final constriction should bemad e with several turns ofth e bandage and notwith a narrow tube . In reply to a query, Howlong can th is bloodless state be main tained ?” hesays, The l im i t ofsafety is not l ikely, he th inks,ever to be reached

,and we n eed not be anxious

on th is score,i f the shut ting out ofth e circulation

be perfect. An imperfect occlusion is dangerous .The blood passes by the arteries into the l imb

,

while the venous Outlets are completely stopped.

The pain i s a great d iffi cul ty in th i s method,but it

may be reduced by not applying the bandage constricting th e l imb above t ighter than is absolutelynecessary — NZY. H osp i tal G azette.

INDICATIONSFO R DR AINAGE OFTHEKNEE-JOINT.

Dr. J . Scriba, assistan t in the Surgical Cl inic' atFreidburg (Baden ) , recommends drainage oftheknee join t, i nstead of excision

,in the following

cases 1 . In acute serous inflammation,in the

rare event of there being abnormal pai n of sufhcient severity to affect the patient’5 general health .

_

2 . In acute purulent inflammation ofth e j oin t,as

soon as there i s distinct fluctuation ; in the rarecase ofos teo m— yel itis, involving one or bothepiphyses ; in the purulen t inflammation whichmay complicate pyaem ia, pneumonia, acute infecti on s d iseases

,and phlegmonous erysipelas ofthe

lower extremities. 3 . In chron ic serous inflammation Of the join t. 4. In fungous inflammation(a) where the fluid secretion in the j oint exceedsthefungous granulation in amount

,and where the

cartilage IS s rill in tact ; (b) where there is excess offungous granulation

, bu t where caries is stil l absent. The presence ofcaries is a contra-indicationfor drainage

,and an indication for excis ion . Scriba

lays down the following maxim,in opposition to

those British surgeons who counsel very early excision : The earlier chronic fungous inflammationof a j oint comes under treatment

,th e better hope

is there ofgiving the patien t a useful movableknee j oin t, by means ofdrainage. I t should bestated that Scriba only speaks Of drainage appl iedto a j oin t w/ziclz i s opened at tlze momen t t/ze tube i s

inser ted , and not to one in which there i s a pre

THE CANADA LANCET.

v ious wound , either surgical or accidental , ofsomestanding. The operat i on, as performed by Scribais briefly as follows . An Incision

, two or three cent imetres long, is made on either S ide ofthe patella ,

down to the j oin t, and a drain-tube inserted. Ifth e bursa, under the extensor muscles, communicates with the joint, as a rule, no further incision isn eeded. In the rare case in which i t is isolated

,

an incision is made down through the quadricepsfemoris, and a short tube inserted. The operationmust be carried out w i t/z tbc str ictest an ti septicp recautions . Before the drainage tube i s inserted

,th e

jo int is swabbed ” with a soft sponge,in acute

cases using a five per cent. solution of carboli cacid in chronic cases , or where there i s fetid ity , atwelve per cent. solu tion Of z inc chloride. Thetube is then put in , and the j oin t washed ou t

through it with carbol ic acid (two and a-half tofive per cent ), until the solution runs clear. During the inj ection , the j oint must be gently kneadedwith the hand . In acu te inflammation

,the tube

must be removed as soon as possible . The greaterpart may be taken out after the third or fourthdressing, i f th e wound Is perfectly sweet, and theremainder on the tenth to fourteenth day. If thesecretion does not qu ickly d iminish

,the j oin t must

be washed out again w ith carbol ic acid,and the

drainage somewhat prolonged,bu t the whole tube

must never be left in after the tenth to twelfth dayfor fear Of irritating the cartilage on which it l ies.In chronic cases

, or when fungosity is present, th etube must be allowed to l ie across the cavity ofth e jo in t for twenty or thirty days

,in order to

s timulate the l ining membrane. Times and

G azette, Sept. 1 sth , 1 8 7 7 .

EPITHELIOMA OF THE CER VIX UTER I .(C L IN IC BY PROF. THOMAS . NEW YORK.)

Before bringing in th e first patien t whom I haveto show you to-day, gentlemen , I wish to presentto you a specimen

,for which I am indebted to the

kindness of Dr. B . F. Dawson . I t is,as you per

ceive,a mass oftissue, which , upon on e s ide

,has

the appearance of a piece ofcooked meat,as in

reality i t is while upon the other s ide,i t presents

a gangrenous and pu trefying surface. The specimenis taken from a case of the same character as I haveshown you a great many times here already

,and

which , unfortunately, I shall, no doubt, have theopportuni ty of showing you many times in thefuture, v iz .

,cancer ofthe cervix uteri . The patient

from whom this was removed presented thewen

known symptoms, the cachexia and the profusehemorrhages

,alternating with watery discharges

,to

which I have so Often called your atten tion.

In considering whether to operate in these cases,

i t i s well to Observe the general rule,that

,if it i s

THE CANADA LANCET.

re to do so .

he Operationt at least acrable retard

for a patient

as a rule,within six months

,

months after the operation .

the disease has spread so asle portion ofth e uterus , orstil l l ess can be accomplishemoval, and it Should onlysake ofchecking severe

the dangerng mass ine measureprolongingre comfort

Eight years ago I removed a cervix which waspronounced , by Professor Delafield and other competent microscopists

,to be cancerous . One year

afterward the patien t married,and up to th e present

time (for she stil l returns annually to Show herself atthe cl inic) there has been no return whatever ofthe disease. But this i s absolutely the only casewhere I have Operated , in which the carcinomatousgrowth has not reappeared and the number ofmyoperat ionsfor this affection must be pretty large byth is t ime, as I perform at leas t five or six of themevery Winter. You may

,perhaps

,ask why cancer of

the u terus should be so differen t in this respect,

from that situated in many other parts ofthe body,and I will explain th is to you . When the seat ofthe disease is upon any ofthe external parts , thepatients

’

s attention i s directed to i t (as,for instance,by a li ttle lump in the breast), at a very early stage ,and before the general system has become involved .

In the u terus, however, cancer goes on developing for months, entirely without the knowledge ofthe patien t, since any indefinite symptoms to whichIt may give rise are very apt to be attributed to thechange ofl ife

,i f th e patien t is approaching the cl i

macteric period . At last,during coitus , and W i th

out any apparent cau se,th ere comes a profuse gush

Ofblood,and the patien t

,becoming alarmed , seeks

medical advice. The physician,after making an

examination,reveals to her the nature of the case ,

th e cervix, followed by the most bril l iant resu lts .Some ofthem were cases ofmal ignan t disease

,and

some of hyperplasia ofthe organ due to some othercause , and his success a t once brought the operation into great repute . Not long afterward , however,h is intern e publ ished a second report Ofth e samecases, wh ich showed that Lisfranc

’s statementswere frequently false

,and that a large number of

th e cases had d ied soon after th e operation . Thisoccasioned a notable controversy in med ical circlesin Paris , and had the effect ofthrow ing a great dealofdiscredi t on amputation ofth e cervix

,which has

prevailed in the profession until qu ite recently.

When performed by the knife or scissors,i t is ap t

to be exceedingly dangerous,from the severe

hemorrhage almost unavoidably occasioned by i t,

and at the present day I hold that i t is very wrongto run the risk of using such means

,unless some

particular end i s to be gained by S O doing. By farthe best and safest method ofremoving the cervixi s by means ofthe galvano-cautery. A platinumwire

,th e tension upon which is regulated by a screw

,

i s made to encircle the cervix,and imbed ed i n the

tissu es at the poin t where the amputation is to bemade

,wh ich should be entirely above the seat of

disease,i f possible . When the wire i s brough t to

a sufficien t temperature by the electrical current,i t

i s slowly tightened,and at the same time contin

nou s and some what forcible traction is made uponthe portion ofcervix to be removed

,by means of

a strong pair ofsharp- toothed forceps. This latterprocedure has the effect ofproducing a hollowshaped stump

,and in th is way a great d eal more

of the tissues ofth e u terus is removed than if theamputation i s made straigh t across . In th is operation there is almost no danger

,and I have seen a

bad resul t follow i t in but one out Of the very largenumber of. cases in which I have employed it. Th i sresul t was pelvic cellul itis ; but even in that cas ethere was some doubt whether th e cellul itis wasreally caused by th e Operation . The hemorrhagefrom It is exceed ingly sl ight, frequently not amounting to ten drops altogether ; and Dr. Byrne , ofBrooklyn

,who has, perhaps , used the galvano

cautery more frequently in the amputation Ofthecerv ’ i h 1 any on e else, attributes the remarkableimmun ity from septicaemia which has been noticedafter i t to the fact that the absorben t lymphaticvessels are all closed by the operation .

R ecently, I was summoned to a neighboring cityto testify in a suit for malpractice brought agains ta physician ofhigh standing, by a patient in whom

if he thinks bes t,and tells her that the disease has he amputated the cervix five years ago with th e

d evelopingfor six months,or perhaps a year. galvano-cautery. The condit ion on account of

The tru th is,that th e cancerous growth has been which the su it was institu ted was th e closure ofth e

out ofsight,and

,th erefore

, out Of mind , and i t has u terin e canal (wh i ch prevented the escape of.

th enow passed beyond the stage when amputation ofmenstrual blood) , In consequence ofthe operauonthe cervix would probably have cured it. bu t I was not called upon to give my opm ion i nSqm e years ago, th e famous Lisfranc reported th e case, for Othe reason that the j udge very wisely

over a hundred cases ofsuccessful amputation Of gave h l S dee1s1on In favor ofth e defendant before

174

i t came to trial at all . These contractions,I may

explain,follow the use of the galvano-cautery in the

majority ofinstances. Some writers claim thatatresia of the uterine canal invariabl y results fromamputation by i t but

,from my own experience

,I

can emphat ically deny this. Only three days ago,

I saw,w ith Dr. J . B . Hunter, a patient in whom

we performed the Operation by this means somel ittle time ago (on account ofan exceed ingly longand con ical cervix, which actually proj ected fromthe vulva and ent irely prevented sexual intercourse) ,and wefound the canal qu ite as large as in theordinary normal u terus . In perhaps forty out Offifty instances , however, there will result more orless narrowing, though i t is not very common tofind complete closure of the canal after the operat ion . But the advantages of the galvano -cautery i nappropriate cases, i t must be acknowledged by all ,far outweigh s any such disadvantage as th is andeven if there i s complete atresia of the canal

,i t is

not at all a d ifficult thing to remedy, by means ofincis ion and the retent ion for a short time

, ofa plugin the O S uteri. Surgeons do not give up the amputation Of l imbs because once in a while,withoutany fault of theirs

,the pat ient afterward suffers

from neuralgia ofthe stump,or is unable to wear

an artificial. l imb upon it ; and neither should wegive up amputation ofthe cervix by the galvanocautery because atresia o ccas ional ly results fromi t. —M ed . and S zcrg . R epor ter .

PR OGNOSIS AND TR EATMENT OFDIPHTHER IA.

Dr. Lewis Sm i th,Clinical Professor ofDiseases

Of Children at Bellevue Med ical College,observes

(Amer ican y er/M i a! ofM edical S ci ences October)that the endem ic pers istence of th is d isease in som elocali ties , as New York

,and its {frequent ep idemic

THE CANADA LANCET.

swell ing of the neck,therefore

,seldom occurs in

diph theria or scarlatina wi thout manifest symptomsoftoxaemia, and is to be regarded as a s ign of itspresence. (3) Obstructive laryngitis (4) uraemia ;(5) sudden failure of the heart’s action , either fromthe anaem ia and general feebleness,from granulofatty degeneration ofthe muscular fibres oftheheart

,wh ich is l iable to occur in all infectious dis

eases of a malignant type ; or from ante-mortemheart-c lots. (6) Suddenly developed passive congestion and oedema of the lungs , probably due tofeebleness

'

ofth e heart’s action , or to paralysi s ofthe resp iratory muscles . Death may occur fromth is cause during what seems to be convalescence.The physician is less l ikely to err who bears inmind the possibil i ty ofthese various term inationsand Dr. Smith believes that the condition of theurine is too infrequently and too superficially examined , seeing that it often con tains a large quant ity ofalbumen.

Among the symptoms which render the prognosis unfavorable are repugnance to food, vom itingpallor

,with progress ive weakness

,and emaciation

from the b lood-poisoning a large amount Ofalbumen

,with casts in the urin e, showing uraemia, to

which the vomiting is sometimes,but not always

attributable a free discharge from the nostrils , orocclusion ofthem by inflammatory thickening andexudation

,showing that a considerable port ion of

the Schne iderian membrane is involved : haemorr

hage from the mouth or nostrils and Obstructedrespiration. One

,at least

,of these has been

present in most of the fatal cases which have fallenunder my observation .

I t is remarkable,Dr. Smith observes, that con

outbreaks in country villages and towns, have cern ing a disease which has been so long underaroused great attent ion as to i ts nature and treat wide-spread and able Observation

,such wide dis

ment. N0 d i sease also, headd s , stand smore i n need crepancy of Opinion as to treatment prevails. Th i sofall the l ight which science and experience canthrow upon i t, not only on account ofthe divergenceofviews wh ich prevails respecting i t

,but because of

th e frequency w i th which the p rognosi s~i s bel ied.

This uncerta inty ofprognos is,he bel ieves

,de

p ends much upon the fact that diphtheria terminates fatal ly in several distinct ways, so that wh ilethe patient may seem safe wi th respect to them ore manifest and common cond itions of dangera fatal resul t may st il l occur from some unseenand unexpected cause.

has arisen in part by the d ifferent views taken ofthe nature ofth e disease, but st ill more is due tothe unrel iab il i ty of the statis iscs oftreatment

,owing

to the very varying types the d isease presents evenin the same epidemic

,so that wh i le some cases re

s ist all measures,others scarcely require treat

ment at all . He believes that the germ theory ofd iphtheria has done immense harm by concenw

trating attention so much on local and generalantiseptic treatment

,wh ich

,as far as h is

experience goes,proves ofl ittl e use and

Death may resul t from ( 1 ) d iphtheritic blood he is ofOp in ion that the fact ofthe treatp oisoning ; probably also from

"

( 2 ) septic poison ing ise in Ziemssen’s Cyclopaedia which propagatesp roduced by absorption from the under surface ofthis doctrine

,having been published before Sanne’s

d ecomposing pseudo-membrane— especially when more useful book,has led

,

to great m ischief. Exth is is extensive, deeply embedded, and attended perience has, however, brought on a react ion, and

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I 7 6 THE CANADA

P seudo-membranous lary ngi ti s , th e most formidablesymptom of d iphtheria

,is bes t treated by the spray.

Of twenty-five cases treated by Dr. Sm i th,seven

recovered by inhalat ion of spray,and two by trach

eotomy. When the S c/z/zeider ian membrane isespecially affected, being more sens i t ive than thefauces

,i t requ ires a m i lder treatment. The best

consists in inj ecting into the nostril s,by means of

a smal l-syringe,every th ird or fourth hour

,one or

two teaspoonfuls ofa m ixture formed of carbol icacid gtt . xxxiv.,

glycerine 3 i j .

,and water 5 vj. ,

u sing i t ofthe temperature of the body,the h ead

be ing thrown back, and the eyes covered w i th a

cloth — M edi cal Times and G azette.

IR ON IN EPILEPSY.

In the October issue ofth e P r acti tioner , Dr.Gowers adduces strong ev idence in favour oftheuse of iron in many cases ofepilepsy, a diseasefrom which the drug has been

,perhaps

,too rigidly

p roscribed. In a large number ofcases he hasfound that iron has no recogn isable influence uponthe affect ion , one way or another; bu t there rema inothers in which i t may be employed w ith tempor

ary and even permanent benefit. In those casesin .which its action is transien t

,there is

,at first

,a

marked diminution in the number and severity ofthe fi ts , but if the administration ofthe metal bepushed

,effects which may be regarded as injurious

ensue,the fi ts reappearing wi th al l their former

severi ty. However,there are some cases in which

its action is direct and permanent— in fact,cura

tive. Such cases those in which iron does mostgood— are chiefly nose which stand on the borderland between ep i lepsy and hysteria ; but even insome pu r r l/ epileptic cases iron has been found to

LANCET.

have produced permanent results. Dr. Gowers PR OGR ESSIVE PER NICIOUS (OR IDIOpoints out that anaemia is no indication for the useof iron in these cases

,and suggests that i t may

have a d irect influence upon the nervous system,

l ike z inc,s i lver

,and other metal s

,quite apart from

its haematinic properties . He supports his opinionby brief notes ofafew cases from his out-patientpractice at the Nation i l Hospital for Paralysis andEp ilepsy, guard ing h imself against drawing toorash con clus ions by bearing in m ind the sourcesoffallacy that may arise in testing any therapeuticalremedy in ep ilepsy

, such as the natural variationin frequency of the fi ts, and the influence ofthebromide

,under wh ic h all epileptics are mostly

placed . The frequency with which fits increaseon w i thdrawal ofth e brom ide does not al low ofany conclus ions being drawn as to the effi cacy ofi ron when i t is substi tuted for the latter drug. Ironshould, th en , be given in cases where no othertreatment has been tried , or if the brom ide be takeni t should be added to th is

,and the effect noted .

Thus,in one case where the brom ide had not done

PATHIC) ANZEMIA R ETINAL HZEMO RR HAG ES AND DOUBLE OPTIC NEUR ITIS ; MICR OCYTH/EMIA EPISTAXIS ;DEATH NECR OPSY.

much good , the additions of iron caused a cessat ion ofthe fits , which , however, recurred after atime. In another case

,that of a girl seventeen

years Of age, who had suffered from several fitsdai ly from the age of three years

,the brom ide

alone caused a d iminut ion in the frequency andseveri ty of the fi ts. At the end ofthree monthsbelladonna was added to the brom ide

,and the fits

ceased,and then she took quinine and iron for six

months w ithout having any recurrence. A th irdcase

,that Ofa woman forty—eigh t years of age , th e

subj ect ofattacks ofpeti t mal , occurring at thecatamen ial periods

,was temporarily cured by the

adm inistrat ion of the perchloride ofiron . At theend of eighteen months

,a recurrence of the attacks

was met successfully by the brom ide, and an in

terval oftwelve months offreedom gained ; asecond recurrence took

_place

,and a return to the

iron treatment again proved effectual . One othercase may be mentioned from this paper i t wasthat ofa man twenty-three years of age, who forfive months had been subj ect to severe epi lepticattack s

,mostly n octural. He was treated with ten

min ims oft incture ofperchloride of iron th reetimes daily

,and continued to take it for s ix months,

and during th is time had only two attacks, one inthe firs t and one in the third month of the treatment. After the iron had been left Offhe remainedfree from attacks for four mon ths

,when the fi ts

recurred,and in three months were “ as bad as

ever.” A return to the perchloride at once produced a freedom from attacks during the time hecontinued to take i t. Two instances ofattackswith co-ordinated spasm— lessened or arrested bythe use of iron— are also given.

— T/ze Lancet.

( U nder the care ofD r . S tep/zen Mackenz i e . )

The following careful record of a rare maladywill doubtless be read wi th interest.W. J . aged ten years

,a schoolboy, was

admitted on Sep t. 5 th las t. His father and motherwere al ive and healthy

,and had several other ch il

dren,who enjoyed exceed ingly good health and

looked quite well . The patient had scarlet fever,measles

,and whooping-cough

,previous to h i s

fourth year. He had had good health up to threemonths before admiss ion

,being, however, rather

subj ect to coughs and colds . Had l ived in fa irs iz ed rooms in the east-end ofLondon all h is , life.

Three months before admission,he began to

get whit e,l ike wax or a dead body. His father

THE CANADA LANCET.

vere,but gradually

especially on getHis h ead used to perspire so much as to

pillow,but the rest ofthe body was ‘

freersp iration . He hadfrequen t n ausea, butvom i t. Two month s before admiss ion , hebut wen t out occasionally , though he

care for the exertion . He never fel t warm .

ear.

1 8 th — Very sick headache.very pal e the latter very tortuous z r st.— Vomiting comes on if he takes much foodplaces in exudation . The centre ofhis appetite has been fail ing for the las t fortn ight.re the exudation was th ickest

,had a 2 7 th

— Very sick ; brings everyth ing up is veryThere was one or two small haemor feeble .

a8 th. Distressing vomiting ; surface somewh i t‘

cold pulse scarcely to be counted. Says h eknows he is dying

,and asks to be taken home ,

Was removed by his parents,and taken a distance

ofabout two miles in a cab . Did not complain ofpain or fatigue on the j ourney conversed with h isparent s and brothers

_and s isters . Died at I Ointellect clear and tranqu il to the last .

th e whole field ofth e erect image in the '

almostfully dilated pupil . I t did not appear to be connected with any vessel . Scattered over the rest ofthe ret ina were other smal ler haemorrhages . Therewere no wh i te patches or glisten ing specks. Lefteye i n al l respects the same as right, wanting onlyth e very large haemorrhage. Microscopical exam ination ofthe blood showed great variability in thes iz e ofthe coloured corpuscles . There was a cons iderable number ofsmal l coloured corpusclesnot more than one-quarter the siz e ofthe normalones . Most of the small ones were spherical i nshape

,and ofth e same tin t as the larger ones afew ofthem presented tai l-l ike processes . The re

maining coloured corpuscles had their natural tint.There was no excess ofcolourless corpusclesUrine 30 oz .

,acid ; clear, sp . gr. 1 0 1 5 ; no albu~

men contained 7 per cent. ofu rea , or grm s .

in twenty—four hours . Pulse smal l and soft 3 temp erature

, 99°F. respiration easy, n ot accelerated .

Sept. 1 1 th .—Vomited last n igh t and th is morn

i ng.

roth .— Nose bled during n igh t ; handkerchief

stained with pinkish blood.

1 8th .— Ep istax is murmur very distinct, most

dist inct over pulmonary artery.

a4th .— Murmur conducted wel l into axil la

strongly-marked pulsation ofcarotid arteries loudbellows-sound over veins of neck .

29th.— Tint ofsk in changing colour l ess yellow,

more wh ite systol ic murmur all over heart.Oct. I st, — Nausea and vomiting th is morn ing ;

fel t giddy. Could not si t up when h is bed wasmade . Temperature

,which yesterday was

has risen to-day to4th.

— Bleed ing from gums blood very pink andwatery 3 feel s l ively .

1oth .— No sickness or headache vision reads

1% Snel len with righ t eye ; {Lg and 1% Snellen‘

w ith left eye. Stil l marked optic neuritis, withhaemorrhages in both re tinae . The large patch in .

the righ t eye but l it tl e al tered . Temperature2sth ,

— S ickness and headache .Nov. r ath.

— Distressing vomiting, bringing up agood deal offluid .

1 4th .— Nose bled th is

’

morning— half a porringer

178 THE CANADA LANCET.

The patient was treated with iron,and later with

iron and arsenic combined. He had a simplediet

,and a small quanti ty ofwine. His urine was

examined almost daily ; i t averaged th irty-fiveounces

,was clear

,acid

,and free from albumen

,

and he passed from six to seven grammes ofureadaily. The blood was examined several times ;i t always presented the characters described onadmission .

Necropsy , at patien t? lzome,fora/ewe [tours a/ z'

er

(fert i le— Body a good deal wasted, but not emaciated. Skin much paler than natural

,but not so

much so as during l ife i t had a waxy appearance.Mucous membrane ofmouth, nose, &c.

,very

anaemic . On opening body well marked pann iculus adisposus was seen , th e fat being ofcanaryyellow hue. Muscles ofnatural colour. Per icar

diurn contained excess ofclear straw-coloured fluid.

Heart,not fi rmly contracted

,larger than natural

,

apex formed by l eft ventricle. Both ventriclescontained medium-siz ed clots ofpale, reddishbrown colour

,l ike meat j ell y

,and some fluid blood.

Valves and orifices healthy ; walls sl ightly thickened . Muscle ofboth ventricles ofpale drab orfawn colour

,with pale-yellow mottl ing (fatty de

generation) . Lungs exceedingly pale ; a l ittlewatery flu id could be squeez ed out. Liver palefor the most part

, but with patches of nutmeggyappearance. Spleen ofnatural siz e, firm and red .

Kidneys : l eft very anaemic ; right venously congested ; adrenal s normal . Stomach thin

,but not

excessively so mucous membrane congested andecchymosed. Smal l intestine very th in

,mucous

membrane pale . Large in testine had well markedappendices epiploicae presented no changes exceptth inness . Pancreas natural . Mesenteric glandssmall. R etro-peritoneal lymphatic glands smalland healthy-look ing. Lymphatic glands ofaxil lan atural . Thyroid gland rather large

,bu t n atural

in appearance. Aorta of natural cal ibre, but verythin , pale , and inelastic : no changes in endarterium . Skull wel l shaped but th in . Brain exceed ingly anaemic, otherwise normal . Periosteumremoved from petrous bones : no discolourationor s ign ofdisease. Orbits opened ; containedabundant fat. Backs ofeyes removed ; haemorrhage seen in retinae. Pieces ofclavicle and r ibremoved marrow ofa distinctly red colour.Numerat ion ofth e blood-corpuscles in the fluid

blood removed from the right ventricle was madesome time after the necropsy by means ofDr.Gower’s haemacytometer. The number ofcolouredcorpuscl es was per cub ic m il l imetre

,or

389 per cent . ofth e natural number.R emarks by Dr. MAC KENZ IE — The case is a very

characterist ic example ofidiopathic essential or

progress ive anaemia. The patien t was,however

,

much below the age at which the d isease is usuallyseen .

‘No exciting cause could be discovered.

No history'

ofshock orfrigh t was elicited. The

marked in this case. According to Litten,they

have no diagnostic value in d istinguish ing thisform ofanaemia from others

,for he has found

retinal haemorrhages in anaem ia from uterine cancer and haemorrhage, menorrhagia, and haemate

mesis. I have examined a very large number ofeyes ofpersons sufl

'

ering from cancer, chlorosis,and anaemia from other causes

,without find ing

haemorrhages but,not having examined from the

anaem ia standpo int, I am not prepared to d isputeHerr Li tten ’

s assertion . A point ofmuch interestin the case was the presence of wel l-marked doubleoptic neuritis . I am not aware ofoptic neuritishaving been described

,though I dare say it has

been observed,by other observers in connection

with pernicious anaemia. Many ( C entralblaflf. (1.Med . Wa rm er/L

,18 75 ,

s . in an account ofacase

,speaks ofthe papil la be ing deformed, and of

the whole retina being cloudy ; but it does notappear from his description of the Ophthalmoscopicor microscopic appearances that there was neuritis.In my case the swell ing ofthe d isc was cons iderable

,and the vessels were in places buried in

exudation . The veins were very tortuous , as usualin neuri tis

,but ofpale colour, with a broad l ight

streak . The existence of optic neuritis causedhes i tation in d iagnosis in some who saw the case.Taken in conj unction with the pain in head , anddischarge from ear with deafness, i t certainly suggested coarse cerebral d iseas e. But the headachewas not so severe as is usual in intracranial tumouror abscess

,and when first seen , al though optic

neuritis was present,there had been no purpose

less vomiting. Moreover,th e assumption ofcoarse

intracranial disease did not explain the extremeanaemia. The occurrence ofm icrocythaem ia assisted me to the diagnosis of progress ive perniciousanaemia, and the s

'

ubsequent progress ofthe case,the vomiting, febrile attacks without assignablecause

,the recurring ep istaxis

,and bleed ing ofthe

gums confirmed me in my opinion . Arsen ic, whichhas been so useful in Dr. Byron Bramwell ’s hands,was admin istered in the form ofFowler’s solution ,w i thou t any amelioration ofthe symptoms . Thepost-mortem appearances were those usually ob

served. Dr. Wilks, than whom probably no on e'

has had greater experience in this d isease, saysthat usually no coagula are present in the heart.In th is case clots were present in both ventricles,but quite pecul iar in character. The enlargementofthe heart (undoubted , though the organ couldnot be weighed) remains unexplained. The exi

amination was made by candle-l ight. The marrowof the rib and clavicle was observed to be red. Ihave not yet examined it microscopically. The

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180 THE CANADA LANCET.

renew for a long t ime,wi th care to have occas ional

intervals of four to eight days. The only disagree~able resul ts were sl ight pruritus ofthe neck

,and

d ilated pup ils. He concludes the influence ofsulphate ofatropia on the temperature is absolutelynegat ive . It also has no effect in checking theprogress of the d isease, except so far as the n ightsweats are lessened, and the inval id rests better.IV. Y. H osp i tal G az etle.

COLLOD ION FLEX ILE IN CAS ES or EC ZEMA.

Henry Lawson,M .D . Assistant Phy s ic ian to

, andLecturer on Physiology in St . Mary’s Hosp ital ,says :In my hands

,two bad cases ofecz ema— E. geni

tale and E . capit is— collod ion has shown i tself sovaluable a rem ed ial agent that I lose no t ime inpubl ish ing the resul t

,in order that others may try

i t,and see what the consequences are l ikely to be .

I shal l now descr ibe one ofthe cases .The first case was on e ofE . genital e. The

patient,M . E was a woman aged about forty

seven years,married

,and the mother ofseveral

ch ildren . She was a florid woman,ofan active

temperament,well nourished

,ofmoderate habits

ofl ife, tolerably cleanly, and w ith a pulse strongand ful l and abou t 74 in the minute. She hadlost her courses about two years ago and, indeed,her general appearance was not such as l ed me tocommiserate her very much . However

,an exam

ination of the patient showed that she had beensuffering a good deal . The whole ofth e ne ighborhood ofthe perineum , ofth e parts about thevu lva

,and ofthe inner margin of both th ighs, were

covered with an eruption . And what was i ts nature I t i s diffi cul t to describ e it . I t had a reddish or reddish -purple aspect, wh ich was, ofcourse,caused by the inj ection ofth e parts with blood ;and it could be seen that certain parts were sl ightlyraised while over the whole surface was a sort ofsemi-transparent glutinou s l iqu id mass, w i th hereand there some scaly particles of epiderm is . I tdid not smel l badly, though the entire amount ofsurface exposed must have been quite a squarefoot but i t was accompan ied by great pain, heat,and secretion ofl iqu id matter. Indeed, th e pat ien t declared that i t made her l ife a perfect miserXWell , I first tried tar water, and with some suc

cess,bu t not enough, for after a fortn ight she was

nearly as bad as on the first day I saw her, andshe had been

'

fourteen months suffering under thisd isease. So I resolved to try the col lodion flex i le.

I placed her on th e sofa. And proceeded tol iterally cover the d iseased parts w ith collod ion,and then I put a second layer over the first. Inext d irected her to put on th is material twice or

oftener,i f needful

,every day

,and to come to me

in a week and report progress . At the same timeI forbade her to take tea

,coffee or malt l iquors,

wh isky if she desired i t. Final ly,I ordered

compound colocynth pill , with podophyll in,taken occas ionally at n ight .When , at th e end ofa week

,this

'

patien t cam eto me, I was absolutely astounded at the progressshe had made.

’

l here was not at al l the sameamount ofsecretion over the surface

,and i t seemed

paler, wh i le i t had not extended ln the least degree.She said she fel t she was getting better

,and

b

that

i t was not nearly so painful as i t had been . Ofcourse I s imply repeated the prescript ion

,and

when she came aga i n i n a fortn ight,all appear

an ces of l iqu id on the surface had d isappeared.

The extent ofthe affected parts had d im in ished,

so had the pa in,wh ich was now n early m 7. In

fact, the remedy had acted most sat isfactorily, andthere was noth ing to do but repeat i t. Th is coursewas fol lowed out by the patientfor about twomonths , at the end ofwh ich she presen ted herselfcompletely cured ofthe painful E . gen ital e . —Lerz

( i072 Lazzeez‘.

BREEC H PRES ENTATIONS .— The relat ive propor

tion ofbreech presentations to presentat i ons ofother par ts ofthe foetus, varies cons iderably, asreported from d ifferent institutions. Scan z onigives th e number from the ly ing in asylums ofPrague and Wurzburg as about one i n fifty-s ix.

G renser, in his report ofthe ly i ng 111 inst i tute of

Dresderi for s ix years,one i n sixty-s ix

,wh il e R ams

botham , jr., from the Matern i ty ofLondon

,esti

mates them as abou t one in thirty-five . I havebeen unable to find any rel iable stat istics as to theproport ion of sti l l born ch i ldren l n these presentation s , but it i s known to be large .

T lie progress oflabor l smuch slowet,both in the

first and second stage , when the breech presentsthan it is when the head presents . From the natureofthe presenting part d ilatation is not so read ilyaccomplished , and the parts do not adapt themselves so read ily to the pelvic cav ity.

The breech is more l iable to be arrested in itsdescent than the head . The arres t ofth e breech

,

especially m a primipara,becomes the occas ion of

great and protracted suffering to the mother,very

probable death ofthe child,and a source ofgreat

anx i ety to the physician ; they are, in fact,f01m idable cases to treat, and the physician having seenone becomes very desirous to avoid another. Inasmuch as we can never tell when we are go ing tohave trouble l n these cases

,i t i s better to prevent

the breech becoming arrested if possible. The ruleI have followed 1n my practice for many years nowi s , in al l cases ofbreech presentat ions at ful l time,to bring down a foot. This allows complete controlofthe labor we can hasten i t as the exigenc ies ofthe case may require. Dr. R obert Barnes

, ofLondon, adopted this mode oftreatment in cases wherethe breech becomes arrested. Would i t not be

THE CANADA LANCET.

I prefer to perstage oflabor i svery eas ily, andpon th e mother.oroform ,

thoughAfter the foot

f the O S uteri isand the duration of the

as to th e manner ofperwould l ike to ment ion .

two differen t positions inI n one

,and the most common by far,

flexed upon the thighs,wh ich brings

n ear the os uteri . In the other,the

ded, carrying th e feet near the fundusby th e s ide of the head . Of course ,most diffi cult to manage

,and rarely

have

g the

firm

n for cord,and gives bulk for d ilatation . 5 . Do not hastenthe passage ofthe h ips through the pelvis secureall d ilatation poss ible. 6 . Guide the rotation ofthe child in i ts descent

,so that the abdomen is

posterior in relation to the mother. I have saidthe d iagnosis in these cases

,

diagnosis are so well known ,ou t, that a m istake can onlyand inexcusabl e carelessness .P roceedings M ea

’ieal S ociefy ,

corpuscle possesses a nuc leus , together with anucleolus . Defibrinated blood is poured into analcohol ic solution ofmercuric chloride

,by which

the haematin is dissolved out, whils t the albuminousbody combined with it remains undissolved. I fthese colourless corpuscles are now stained withcarmine and examined microscopical ly they will beseen to consist ofthree parts :a bright homogen louscortical layer, a granular protoplasm ,

and a clearnucleus with nucleolus . The protoplasm surrounding the n ucleus is frequently found mulberry-shaped

,

and bese t with smal l papillae or drawn out into processes. I f the blood corpuscles of a camel are examm ed in the same way the only d ifl

'

erence will befound that the processes of the protoplasm areabsent — Londonfl ospi tal G az ette.

THE UN IVERS ITY or PENN SYLVAN IA.—We are

glad to learn,from the Pfiz

'

laa‘

e/p li ia Mea’

ieai Times,

that the success ofth e new plan ofteaching in thisschool, to which we alluded in our las t issue

,i s

fully equal to th e h ighest expectations,the general

paying class being qu i te as large as i t was last year.One hundred and thirty firs t-course s tudents haveentered for the three-year term . There is said tobe a marked improvemen t in the character ofth enew class — IV. Y. M ea

’. y our .

ANUR IA LAS ’

I‘

ING TWENTY-F IVE DAYS -R E

C OVER v.— The following extraord inary case

, oc

curring as a sequela ofscarle t fever, i s reported byDr. Wm . Whitelaw. The subj ect was a healthyboy ofeigh t. December 3rd , h i s urine was ob

served to be scantier than usual,and the amount

decreased rapidly until th e 7 th , when only one

drachm was passed, and from this date up to thez r st

,not a s ingle drop

,and .yet with the exception

ofa sl ight headach e his general h ealth was excellen t. During th is time diure tics and diaphoreticswere tried w ithou t effect ; on th e 1 9 th a bl ister

pp lied over the k idneys, and in twen ty hourstwo ounces ofurine were passed

,when complete

suppression again occurred . The bl ister was reappl ied ou the 2 7 th, but w ith n o success . D iapho

reties and purgat ives were now discont inued in thehope offorcing the k idney s to act, but no changebecame apparen t in th e condition ofthe patien t

,

who stil l con tin ued in excellen t health . O n December 3 l S t very sl igh t oedema of the feet '

and

ankles appeared and on the morn ing ofJanuary2nd , one d rachm of urine was passed daily, and011 th e sth, a whole p int was voided in smal l quant ities at e igh t d ifferen t times . Since then thek idneys have acted well

,and the boy has (January

1 2th) recovered — flee Lan rez‘,Sept. 29th .

TH E OBLIGATIONS o r THE R ED CROS S S U RGEONS — R eports having reached th is country of aseriou s breach offaith on the part ofMr. Douglas

,

on e ofthe R ed C ross surgeons, we referred to thesubj ect in the following terms

We trus t there is some exaggeration about thestatement that Mr. Douglas, immediately he fel linto R uss ian hands, related stories prej udicial tothe Turks. The fact has naturally caused a strongfeel ing at Constantinople against the R ed CrossSociety ; and Mr. Kennett has issued a circularpoint ing out to the doctors that i n the event oftheir being captured they ought on no accoun t togive any information which could m il itarily or poli tically prej udice the army with wh ich they havebeen serving.

From a letter j us t received from Mr.'

D0uglas,

we are glad to find that our doubts as to the correctn ess ofthese reports, were j ustified, and thath e has completely exonerated h imsel f from th e as

182

pers ion s cast upon h is conduct. We give h is ownexplanationsIn justice to myself and my coll eague

,I beg

to state that a R ussian offi cer having made a re

port ofth e mutilation ofthe R ussian wounded bythe Turks after the battle ofT el iche, we were askedif such things had come under our notice. Wecorroborated the statemen ts of th is Officer by ourevidence . I/Ve str ictly zen/lineal ezrery information ,

m i l i tary or ot/zcrw i se bu t I maintain that from myposit ion as a member ofa R ed Cross Society

,I

was bound not to sh ield such a vile infringementofhuman i ty and modern warfare . I may add that

,

having taken the opin ion ofEnglish correspondentsand others on the spot, they all agreed that wewere perfectly j ustified in so doing. Nor have Imet any Engl ishman since, e i ther R ussoph il e or

Turcoph il e,who d isapproved of the course we

took.

”

Wh i lst upon th is topic we may mention that,

throughout this cruel war,Brit ish surgeons have

greatly d ist inguished themselves by the ir attentionto the wounded , under fire and after engagements .The latest telegram , referring to another memberofthe R ed Cross Society, says Surgeon Gil lgreatly d istinguished h imself

,h is horse was kil led

under h im,and he was commended by Muchir

Pacha for dressing the wounded under a heavyfire.

” —M ea’. P ress and C i rcular .

R ETROFLEXION WITH HYPERPLAS IA OFTHEUTERUS — Th is patient, to whom we have but afew minutes left to devote, comes to u s with adiagnosi s . She was sent to me by a gynaecologistof considerable standing, who stated that she wassuffering from an teflexion of the uterus and a smallovarian cyst. But even the best men are liable tomistakes

,and if he had examined the case a second

time no doubt he would have discovered that th isdiagnosis was incorrect. O f course, i t makes avery great difference to the patien t whether she hasan ovarian cyst or some comparatively trifl ing affection , and we cannot be too careful in our diagnosis.On mak ing an exam ination with the left forefingerin th e vagina

,and the fingers ofthe other hand

pressed upon the abdomen, I failed to find anteflexion , but detected a body feel ing somewhat likean orange beh ind and below the cervix uteri. Thenplacing the pat ient in Sim’s pos ition , and raisingthe side ofth e table on which the buttocks rest afew inches (as is now my invariable custom inmaking uterine exam inations) so as to exaggeratethe posit ion and throw the v iscera well forward, Ipassed the probe and found that i t en tered thecavity for three inches in a direction downwardand backward. Then removing the p robe I succeedeed in getting two fingers under the supposed

THE CANADA LANCET.

the sl ightest uneas iness , and thereby conclusivelydemonstrated the perfect mobility ofthe organ .

The diagnos is , therefore , was retroflexion,wi th a

hypertroph ied and hyperplas tic cond i tion oftheuterus — Prof. Thomas, B oston M eo

’. y our /m l .

TRAC HEOTOMY IN D IPHTHER IA.— Dr. A. M .

Tupper,reports in the B oston M edical an d S urg ical

_

‘

7 ozcr nal , a severe case of diphtheria, wi th invas ion .

ofthe larynx,in a boy seven years old . Trache

otomy was performed on the e ighth day, and the “

patient recovered. The tube was finally removed .

fourteen days after the operation .

LARGE STONE — Prof. C ross, of Philadelph ia,ovarian cyst and w i thout any d ifficulty pushed it operated recently by the lateral method, remov ing;up

,when I re i nserted the probe andfound that i t from a boy, aged 1 2 years, a stone wh ich we ighed;

passed in the normal curve ofthe u terus. I now one ounce and five and three quarter d rachms.

TEAR LEss MADNES S — O n e ofthe most curiousfacts connected with madness is the u tter absenceof tears amidst the insane. Whateve r the form ofmadness tears are conspicuous by the ir absence

,as

much in the depress ion ofmelancholia, or the exc i temen t ofman ia

,as in the utter apathy ofdemen ti

I f a patient in a lunatic asylum be d iscovered intears

,i t w il l be found that i t is e ither a patien t

commencing to recover, or an emotional ou tbreakin an ep ileptic who is scarcely truly insane ; wh il eactually insane patients appear to have lost th epower ofweeping— it is only return ing reasonwh ich can once more unloose the fountains ofthei rtears . Even when a lunatic is tell ing on e in fervidlanguage, how she has been deprived ofher ch ild ren ,or the outrages that have been perper trated onherself

,her eye i s never even mo ist . The ready

gush oftears wh ich accompanies the plain t ofth esane woman contrasts wi th the dry-eyed appeal ofthe lunatic. I t would, indeed, seem that tears giverel ief to feel ings which when pent up lead to madness. I t is on e ofthe privil eges of reason to beable to weep . Am idst all the m isery ofthe in sanethey can find no rel ief in tears — B r i ti sh M ed .

r

j t'

ozcr .— M ed . News.

R ES IGNATION or MR . SPENC ER WELLS — C mth e r ath December last, after performing ovariol

tomyfor the the 4o4th time at the SamaritanHospi tal

,Mr. Spencer Wells said that he was now

retiring from the act ive work ofthe hospi tal , having .

been elected consulting surgeon,and that he had

now operated probably for the last t ime in the

hospital . It is bel ieved that Mr.Wells has operatedin hospital and private pract ice more than 900 .

t imes ; and in the 404 hosp ital cases the totalnumber ofdeaths was 99, the percentage having '

gradually diminished from 33 to 1 0 per cent.[ oi /l .

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184

trolled and itsfatili ty prevented by the use Of suchremedies as sulphur in the powder blown into

the throat every half-hour, or by chlorine water, diluted with two to fou r times its bulk of water and

used as a spray to the throat,or as a gargle. This

fungus is ofa contaminating nature and hence ifallowed to develop will vitiate the secretions of the

body,and if i t does not accumulate in suffi cient

quantity to induce strangulation wil l prove fatal by

its influence upon the nervous centres,producing

paralysis.

Isolation is imperatively demanded to prevent

the possibil ity of direct contact with the germs ofthe disease

,cast about with the excretions

,especially

the saliva. So virulent i s th is,that a child picking

up a-canula which had been in another child’s

throat and putting it to i ts mouth , took the disease

and died in a short time. Cases have also been

known to occur from c ontact ofthe l ips in kissingthe corpse. In the early stages the sulphur orchlorine water is most effectual

,but when the fal se

membrane has already formed someth ing more

destructive is requ ired, and a weak solution ofcarbolic or sal icyl ic acid in glycerine is very effectual . Destructive agents in the early stages are

very prej udicial to the success ofth e case. The

chlorine water is par excellence the remedv for this

affection in its early stages. We have not referred

to the vexed question ofcontagion or infection torender precaution against its spread less incumbent

,

but to show that only by direct introduction ofthediseasegerms into the sys tem can it be spread fromone to another, and th is result can be prevented

only by isolation .

An article on Diphtheria by Dr. Lewis Smith, of

New York, will be found in th is number, page 1 74,

and is worthy of a careful perusal .

MEDICAL EDUCATION IN THE PR O

VINCE OFQUEBEC.

Since the inception ofthe presen t medical Billofthe Province ofQuebec, matters have not beenrunn ing in their usual smooth current

,and at the

present time— asidefrom the charges made againstthe late R egistrar— there exists a bone ofcon tent ion ofserious import, as i t affects al ike all theteaching bodies in that Province unfavourablyexcept on e— that one being its promoter. A good

TIIE CANADA LANCET.

6

deal of anxiety has been manifested by the medicalfaculties of McG i ll and Bishop’s College Univer

sities,with regard to a propos i t i on of Laval to

alter the duration of the course of medical lecturesfrom six to nine mon ths . The latter term is thatof Laval at Quebec, while the six months

’ course is

the one followed by the two Engl ish medical

schools in Montreal, as well as by that oftheFrench branch of Victoria University, and is alsothat establ ished by the law ofthe Province. “ I t is

also the term ofthe other medical facul ties in theDom inion and in Great Britain

,and its superiori ty

over the n ine months ’ course is thus generally

acknowledged. The actual number of lectures

given in each case is the same,only in the one

they are spread over a longer period oftime.Under the circumstances, i t was necessary for

Laval ei ther to reduce the duration ofher courseto six months

, or to secure a change in the law ofthe Province by which nine months should be

made the legal term . The proj ect to alter the lawIn the intere sts ofLaval naturally meets with strongOpposit ion on the part ofthe facul ties of McG ill

and Bishop ’s Colleges, who claim that such achange would affect their medical schools d is

astrously. At present the great proportion ofth estudents in both schools are from Ontario, theMaritime Provinces and the United States. {Acompulsory adoption ofth e nine months ’ cou/rsewould drive all these students away to other sch

where they could save three months timeattendant expenses, and would infactdestroy the influence ofMontreal asmedical education .

I t was the intention ofthe promoscheme to call a special

for adoption by the Legislature at its present session

,but owing to the vigorous remonstrances o

\f\

McG ill and Bishop’s Colleges, th e matter is to be

left over until the regular meeting of the Board in

May next .

Some persons may be curious to know how ,th is

new movement ofLaval i s go ing to affect theFrench medical school affi l iated to Vi ctoria University . From al l we can learn i t is to be absorbedand swallowed up

,although the victim has been

und ergoing a sort oflubricat ing process before itwould go down . At first Laval was incl-ined tobreak bones

,and only take two or three ofthe

THE CANADA LANCET.

be snuffed out so easily, and

found they cou ld retain their

ntinue to maintain thei r school

Consequently,Laval had to

the whole staffOfVictoria.

ng studen ts away from suchcompelled to adopt i t, andinevi tably ru in the medical

McG ill College and Lennoxville,as is

its evident intention . I t i s to be hoped no suchsu icidal policy will prevail.

INEXPEDIENCY OF PHYSICIANS DISPENS ING DR UGS.

The Operation ofthe several pharmaceuticalActs passed by the Legi slatures ofOntario andQuebec in recen t years, i n regard to curriculum ofstudy and examination of drugg is ts, has been al l

be desired . The examinations havebeen, year by year,

.

made more comprehensive and

searching, until they may now be considered asrapidly approach ing to the high grade of the

French pharmacien , and the yearly supply ofpassed candidates is fully equal to the require

ments ofth e profession. With then,this ad

vanced knowledge ofpharmacy on the part ofthe druggists, th e time has surely arrived formedical men in accessible reach ofa druggist

,to

abandon the combination ofprofession and trade.This s trange combination ofphysician and drug

.

gis t in the same ind ividual,is the principal cause

ofthe anomalous state of the profession in Canada.

Med icine is the only learned profession that hasever been associated wi th trade. The practitionerwho dispenses medicines, has a great portion ofhistime occupied with matters entirely foreign to the

science he professes , dissonant from the habitualtone of h is m ind , and hence to the las t degreeirksome an d disgusting to him. Many a valuable

THE MONTR EAL MEDICAL LICENSECASE.

For some time past th i s casus celebre has been

before the Courts in the City ofMontreal . Dr.Gilbert, of Sherbrooke,Que ., charged Drs. G. E . Fenwick, ofMontreal , and E. D. Worthington , ofSherbrooke, th e former the late R egi strar, and the latter

a Governor ofth e College ofPhysicians and Surgeons ofQuebec, with “forgery in issuing a cer

tain l icense to Dr. Mines ofMassaw ipp i , Que. , agraduate of McG i ll College , wh ich had been antedated to 1 8 7 5 instead ofbearing the date of issueJ une 1 8 7 7 . Dr. Mines grad uated in McG ill Col

lege in 1 8 74 and practised for some time in th eProvince ofOntario, but subsequently settled inMassawippi in August 1 87 5 . I t appeared from the

evidence that he never presented h imself before

hour that he would gladly devote to study, i swasted in making up medicine

,not half ofwhich

wil l ever be swallowed, or bills, not half ofwh ich

will ever be paid. He returns from visi ting a

difficult case, -What author does he take up to

ass ist h im in i ts consideration 1 N0 author, alas

but the t ime that he would gladly give is taken up

with preparing med icinesfor patien ts h e may findin h is ofli ce. He returnsfrom an interes ting postmortem , and would wish to consul t Paget or

R okitansky but, i t wont do, Mrs. Gripes has j ust

sen t for a pill, and Mr. C rumble for a m ixture.With such stuff '

as this, too much Of the t ime is

taken up , which ought to be devoted to science and

letters . I s i t to be wondered at that French andGe rman physicians claim the ascendancy in scien

tific medicine P

In order al so to raise the science ofmed icine toa higher level, a tariffOffees graduated accordingto the circumstances ofpatien ts

,should be recog

n ized by the courts . I n this way the disgracefulcontentionfor patients

,by undercharging, would

be in a measure diminished. The code ofeth icsadopted ' by the Canada Medical Association

should also be recogniz ed by every pract i t i oner as

h is rul e ofprofessional l ife,and las tly the provision

in th e variou s Medical Acts for th e due prosecutionofquacks and impostors

,in those Provinces in

wh ich the Acts are in force,should be made a fact

,

no longer as at presen t a fiction .

THE CANADA LANCET.

the College of Physicians and Surgeons ofQuebecto Obtain his l icense as was required by law

al though he was entitled to i t. The gravamenofthe charge lay in the fact that Drs. Fenwick andWorth ington issued a l icense to Dr. Mines, withou th is conforming to the letter ofthe law, in Junelast, which was purposely antedated to 1 87 5 ,

in

order to secure h is vote at'

the election oftheBoard of Governors.From all that has been el icited in evidencethere

does not seem to have been anyth ing more than

a grave irregularity comm i tted,and for which nu

merous precedents exis ted. The Intent to com

mit fraud was not proven . A good deal ofbitterness and il l feel ing was also shown to have existed

between Drs. Gilbert and Worthingt on for yearspas t.

I t is unfortunate that there should have beenany irregularities in the conduct of th e affairs of soimportant a body

,but poss ibly the lesson may be

salutary in its effects upon others holding offi cesofpubl ic trust. I t often happens when men are

allowed to have publ ic affairs under their owncontrol for too long a time

,they begin to consider

i t their business to do as they please. This said ,we trust, as no interest has seriously suffered andno harm been done to any one, that the magis trates

del iberation may resul t,as has already been fore

shadowed, in dropping the case al together. I t

cannot be said however that Dr. Gilbert had no

groundsfor bringing the ease in to Court . We

are glad however for the sake ofth e profession inQuebec, and also the medical men concerned that

the case 15 about to be satisfactorily te rminated.

ONTAR IO MEDICAL BOAR D.

At the last meeting ofthe Ontario MedicalCouncil i t was decided to hold the examinations in

the latter part of the month ofMay— one month

later than usual . I t was alleged as a reason forth is change that the medical s tudents were in the

habit ofdeserting the lecture room , (an allegation ,

not very flattering to the lecturers) about the latterpart ofFebruary, in order to cram for the ex

aminations in April. Th is statement,whatever

may have been the experience of those who gaveutterance to it, is not generally true . Upon

THE GR EAT WESTER N R AILWAY MEDI

CAL TAR IFF.

[The following letter was received too late fori nsertion under the head of correspondence .]— Ed .

To the Ed i tor ofthe C ANADA LANCET.S IR , -In your last issue, I observe a letter from

Brantford signed D . L. P.,in which great fault is

found with the Great Western R ailway C O ., for the

making careful enqu iry,we find that the attendance “ insult offered the profession,” through the arrange

session . Our Object at theever

,to discuss the question

lectures,but to poin t out the disadvan tages under

which the s tudents labor by reason of th is changein the date of examination.

In the first place,the effect of th e present

arrangement is to prevent al l students who may

desire to do so, from attending any of the summer

courses of lectures, either in Canada or the Un itedStates

,until the sessions are far advanced. A

summer course ofl ectures was delivered in McG ill

College last year,commencing on the r s t May,which

was most succes sful in point of attendance and in

the character ofthe instruction given. A summer

course was also advertiz ed in one ofthe medicalschools in Toronto

,

- but with what measure ofsuccess we are unable to state. I t would almostseem

, (ofcourse we do not wish to impute motives , )as if those who secured the passage of the regulation

,did not desire that the students should have

an opportun ity o f avail ing themselves of any other

course of instruction , except the lectures del iveredduring th e winter sess ion . The students are also

put to greatly increased outlayfor board and travel~l ing expenses

,which many ofthe most deserving

can il l afford. The period which they should

spend in the ofli ce of a medical man is also verymuch curtailed

,and those who desire to go to

Europe to complete their course ofs tudies aredetained until late in the season . We understandthat the students of the different schools have sentup petit ion s to the executive committee, sett ing

forth the disabil ities under wh ich they are placed,and asking to have the time of the examinationchanged to the month ofApril as heretofore.

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188 THE CANADA LANCET.

respondent ofthe London New s was nearly poi

son ed a short t ime ago, by eating honey obtained gate, ofGranton , Ont.,from the Batoum valley where hemlock and hen tune of by t

bane grow abundantly. After partaking of it he England. He leaveswas seiz ed with headache , vomiting, coldness ofth e present receiving the cextremities

,and temporary bl indness. The honey

derived from the Azalea Pontica, an eastern plant,is said to be very poisonous.

ELECTION To THE MED IC AL COUNC IL — Dr.W. L. Herriman ofPort Hope has been electedto represent King’s and Queen ’s Territorial Divi

sion in the Medical Council ofOntario, z'z'

ee

Dr. Dewar deceased. Dr. Herriman will make anexcellen t representative and a worthy successor of ggpoxtg uffiugiptigg.th e . late Dr. Dewar.

GROWTH IN THE HUMAN FAM ILY. -The rate of HURON MEDICAL AS S OC IATION .

growth ofthe human family is curious. The most

rapid increase takes place immed iately after birth,

the growth ofan infant during the firs t year beingabout eight inches

,the ratio of increase gradually

decreasing until the age of three years,at wh ich

time the siz e attained is half that wh ich wil l bereached when full grown.

CHEM ISTRY OFCOMMON LIFE— Pane ", says adistingu ished Professor of Chemistry

,suggests that

the nomenclature of that scrence m ight be drawnupon for a variety of pretty addi tions to femalenames. Having himself a family offive girls

,he

has named them respectively, G lycer i ne, P eps ine,E t/zy l, M et/zy l and Morp/zza.

PO I S ONOUS EFFEC T OFEMERALD ‘

GREEN.—An

English medical practit ioner calls ‘

atten t ion to theinj urious effect arising from the use of colored

wool— more especially that shade of color sofrequently selected

,and known as emerald

,

green .

He says he has lately witnessed an instance of

arsen ical poisoning arising from i ts use,and on test

ing a portion ofthe wool the lady had been us ingfound it largely charged with arsenic.

ING LU VIN.-In our last issue we mentioned

among the important n ew remed ies, “ d igestin .

”

This should have been written Ingluvin. This

substance was originally called d igestin , but as

there was a patent med icine on the market of thatname, i t was changed to Ingluvin. I t is muchsuperior to the ordinary pepsin preparations.

FOURnals wil l

rates quand B raz

'

tfiwaz’

le’s R etrospect , $5 CANADA LANC E r

and S er z‘

oner’

s Monthly , $5 ; CANADA LANC ETand New Dom in ion Mon t/zly, $4 ; or allfourfor$ 8. (See commutation rates .)

At a meeting ofthe above Society,hel d in

Clinton , on the 1 7 th ofOct., the following wereappointed officers for th e ensuing yearPresident— Dr. Worthington , ofClinton ; Vice

Presiden t— Dr. McLean ofGoderich Secretary

Treasurer— Dr. Stewart,of Brucefield .

Dr. Sloan, ofBlyth , exhibited a patient affected

with exophthalmic goitre. The palpitation,thyroid

enlargement, and exophthalmos wereallwellmarked ,especially the latter. The skin in this case was

very dry. Urine copious,very pale

,and oflow

specifi c gravity,bu t free from both sugar and albu

men . Urine has been examined both during fasting and after a good meal. I t is free from casts

,

but contains a large quanti ty ofminute oxalate ofl ime octahedra. This patient has improved underdigital is and ergot. I t i s a well known fact that

there is an intimate Connection between Graves ,

disease and temporary albuminuria,and also

diabetes melli turs, but we are not'

aware of having

read of a connection between Graves ’ d isease and

d iabetes insipidus.The last meeting ofthis Association was held

in Wingham on January 1 5 th . The followingmembers were present— Drs . Worth ington

, Be

thune,Sloan

,Tamblyn

,Towler, McDonald

,G ra

ham,Gordon , Young, Hurlburt and Stewart.

'

Dr.Worthington occupied the chair. Dr. Sloan showed

a woman, aged 35 , who has a pulsating“ tumor

situated over the lower and anterior surface of therigh tfemur. A soft and blowing bruit is heard'

over it. Pressure'

on the femoral immediately

THE CANADA LANCET.

th e pulsation Administration ofC hloroform, &c. 2 00 to 5 00

tly l im ited or Natural Labor 0 0 o o o o o o o 0 0 0 0 0 0 0 0 0 0 5 00 to I O 00

M i leage over two extra.which corres

to 5 inches ,to 3 inches .

natom ical supply cannot be made out

movable over the bone, and has no

to the skin . I t has no bony envelope .

years standing, and . th e patien t says it

used by an inj ury.

Stewart and Hurlburt showed a fair haired,

e boy, aged 6 years, who is wearing Sayre’s

er j acket ”for lateral curvature ofthe sp ine.us to the application pfthe jacket he was

t Since it was put on

is general health i s

that he is free from

instructive paper on

details of3 cases ofs idered occupied the

o id and the

two ofth ereported cases there seemed to be but l ittl e doubt

but that the fever arose spontaneously.

Dr. Towler reported an unique case which cameunder h is observation in Obstetrics lately. As a

full,report ofth is case will shortly appear in th e

LANC ET, i t wil l be unnecessary to give an abstract

cDonald and Graham were appointed

e next meeting of the Associa

held in Cl inton, on the roth

-The fol lowing is the tariff ofHuron Med ical Association :

00 to $2 00

2 00 to 4 00

1 00 to r so

Night.. I 50 to 2 co

to two2 oo

50 per mile.

Q

0 0 0 0 0 0 0

R educing

5 0° to 1° 0°

R educingO O O O O O O O O O O O O Q I O 00 to so 00

Diffi cult, Complicated or Instrumental 00 to 20 oo

R emoval ofR etained 5 oo

Speculum I 00 to 2

tantrumgaspimt fictions.

(R eported by Wm . McKay, Trin ity Med ical S chool. )PERFORATION OFTHE STOMAC H .

00

Jane McN aged 22, a native ofCanada .

Admitted into the Hospital on the 13 th ofDecemuer

,1 87 7 , complain ing ofpain in the stomach

,

also in the back ofthe chest and shoulders. She

first noticed it one night in August last when she

was runningfor a medical man,and attributed i t

at the time to the exertion . The pain extended to

the l imbs,and has been more or less severe. For

the past two weeks she has not had much appetiteand has been vomiting a great deal ; was able to

work unti l four days ago since lheu She has beenfeeling generally worse and now feel s almost unableto move. Has been perspiring freely for somedays past bu t not previously. Has been somewhat constipated habitually, and especially so within the pas t five days. Has had several enematabut without effect. Tongue coated brown andmouth has been thickly coated for three or fourdays. Pulse is wiry and quick I 5 2 respiration issomewhat laboured and causes pa in In the posteriorpart ofthe chest. “ Changes have been scantybut quite regular every three weeks for some timepast. For the past few days micturition has beenpainful and scalding, and urine is scanty, with adark sediment. Has had no sleep for two nightspast on account ofpain .For two weeks pasthas fel t a hardness over the stomach

,and the en t ire

abdomen is now tender, causing pain on sligh tpressure. Was ordered repeated turpentine enemata which rel ieved the lower bowel . Also stimulan ts to support the s trength , and morphia to allaypain .

Dec. i 4th.-Died at one o ’clock p. m .

Dec. i sth.— Post-mortem examination shows

the pericardium inflamed on th e outer and left surface , and containing rather more fluid than normal.Internally i t i s inflamed at the base. The heartweighs 10% ounces. The righ t ventricle contained a small quantity of fluid blood

,and a large

well organiz ed clot. The left ventricle i s emptythe valves are normal . The auricles each -containa large firm clot extending to the ventricles. Thelungs are emphysematous on the surface and espe

190

cially on the left side. The abdomen is fi l led withmuco—purulent fluid containing shreds offalse membrane. Peri toniti s is general , extending over thel iver and under surface ofthe diaphragm , etc., andfalse membrane can be dissected off.The transverse colon turns downwards and then

upwards to the left hypochondriac region .

The stomach shows on i ts upper and posteriorpart

,j us t beneath the centre ofthe left lobe of

the l iver,a smal l irregular perforation , also d is

tinct marks of previous ulceration . The glandsaround the pylorus much enlarged , and the rugoe

well marked and inflamed in patches. The intestines show true inflammation but not enough tocause obstruction. The il ium i s inflamed inpatches. The ileo-caecal valve heal thy. The spleenis normal . The l iver weigh s 3 lbs, is healthy inappearance . Ductus com . choled . i s obstructed.

K idneys sl igh tly inflamed on the surface , but otherwise normal . Uterus virgin , and normal . Cysticdisease in both ovaries .

£ 00334 and maturing.

THE FUNC TIONS or THE BRAIN, by David Ferrier,M .D. ,

King’s College, London. I llustrated . New York : G. P. Putnam ’s Sons.Toronto Will ing Will iamson.

The author presents to the professional readerin this work

,a systematic exposition of the bearing

ofhis experiments on the functions of the brainand spinal cord, or the c erebro-spinal system in

general. I t is a work ofabou t 300 pages octavo ,and is a h ighly interesting resum ofthe knowledgeso far acquired regarding th is intricate subj ectthe function ofthe brain . The discovery oftheelectric excitabil ity of the brain by Fritsch andHitz ig, has given afresh impetus to researches onthe function ofthe brain , and thrown new lighton many hi therto obscure points in cerebral phy_

s iology and pathology. Much stil l remains to be

done,and it i s useful to review the knowledge so

far acquired,in order to show how much yet

remains to be done .

A TREATIS E ON G ONOR R Hcm AND SYPHIL IS , bySilas Durkee

,M .D . , Boston. Sixth edition,

with eight colored il lustrations. PhiladelphiaLindsay 8: Blakiston. Toronto : Hart R aw

l inson .

Dr.Durkee’s work was first publ ished as an

essay on the Constitutional treatment ofSyph il is,”and as such secured the Boylston Pr iz e. This

essay constitutes a. large portion ofthe presen tvolume

.The author has had large experience ,

THE CANADA LANCET.

The work w . ll be found to be a most valuable

addition on venereal diseases.

How TO U SE THE OPHTHALMOS C OPE,for th e useof students

,by E. A. Browne , Liverpool Eye

and Ear Infirmary,pp. 1 20 . Philadelph ia H .

C . Lea. Toronto Will ing 81 Wi l l iamson .

fi irflt warriagra, 213mm .

On the r 1 th ul t.,the wife of Dr. A . H . Wright,

Toronto,of a daughter.

In Dec. , 1 8 7 7 , Frank Lawson, M . D.,of

Bedeque, P. E. I .In Montreal

, on the 24th ult., Hector Peltier,M.D .,

Prof. ofInstitutes ofMedicine, in theVictoria Med i cal School .

THE AG I IO I OFMED I C INES , by Isaac O t t, A.M .,

M.D .,

.ormerly demonstrator ofexperimentalphysiology

,Univers ity of Pennsylvan ia. Ph ila

delphia Lindsay Blakiston . Toronto Hart’

R awlinson .

This is a smal l octavo containing about 1 60

pages,and i t is devoted to a consideration

“

ofthephysiological action ofmedicine upon the loweranimals and man . The detail s ofthe method ofexperimenting upon an imals are given briefly alsothe results ofthe d iflerent experiments and th edeductions to be drawn from them . The workwill be chiefly serviceable to those who are engagedin experimenting. The author also mentions atthe close ofthe work

,the manufacturers from whom

the instruments used in these experiments may beprocured .

On the r st ul t. , Al exander Kennedy, M .D ., M .

C. P . S . ofPort Perry,to Ida, only daughter of

Edward Howard,Esq. ofBath.

On the 14th ult., A . J . Masecar , M . D . ofTIl sonburgh

,to Miss Van Patter

,youngest daughter of

the late A. Van Patter , Esq.,Aylmer, O ut.

On the 2 2nd ult., at the residence ofthe bride’sfather

,by the R ev. E. Hooper, assisted by the

R ev. John Gilchris t,of St. George, James Sinclair,

M . B of Hastings,to Emma

,youngest daughter

ofCyrus Kilborn e, Esq., of Beamsville.

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194

far more l imited than surgical writers are in thehabi t ofenumerating. Of these conditions

,con

stitu tional and local are the principal . From thefi rs t we may have general physical debil ity and con

sequent atony ofthe injured parts a lack Of vas

cular action and supply, not only in the broken

bone,but al so in other parts ofalmost paramount

importance, namely the structures and soft t issues

immediately surrounding the broken fragments.As to the local causes occasionally i t may besomewhat d ifli cult to arri ve at their precise nature

,

but,as Gross Observes, i t i s not improbable that

their influence has been greatly exaggerated .

Some wri ters would fain persuade us to bel ieve

that the absence Of reparation in these cases alto

gether depends on the relative s ituation of the

fracture and nutrient vessels ofthe bone, as forin stance, that fractures in the upper part oftheshaft Of the humerus fail to receive suffi cient nourishmen t in consequence ofthe downward courseofthe nutrient arteries , and in l ike manner

we are given to understand that when the lower

ends ofthe bones of thefore-arm ,or femur, are

broken,that we must expect union to be more or

l ess delayed,because the arteries ofth e bone take

their course upwards, and thus forsake the damaged

parts. But it is certai nly fortunate as well as true

that in spite ofthe oppos ite course ofthese nutrientvessels, union is generally Obtained in very goodtime. The soundness of such a theory is very

questi onable,for many ofthe best practical sur

geons tel l us that they have met with.

cases Of de

layed union where the fractures have occurred in

those parts ofthe bone usually traversed by thenutrient arteries

,about as Often as in part s which

are said to labour under the disadvantages of d efi

cien t supply,and that, in either s ituation , th e length

oftime required for final and complete consolidationhas been about the same. Wi th this statement I

fully concur, after experience in and observation ofthese matters for the last forty years. Norris, in h isanalysis of forty-one cases, found that twenty-seven

were in the direction ofthe nutritious arteries, andonly fourteen in the parts supposed to be less

nourished.

In these unpromising cases, i t is always expedientto obtain consol idation by the safest and most simple method

,studiously avoiding all extreme meas

u res,for the mere irritation produced by a seton w il l

occasional ly lead on to diffuse inflammation , sup

THE CANADA LANCET.

STR ANGULATED FEMOR AL HER NIA.

SUCCESSFUL OPER ATION AFTER TEN

DAYS’ STANDING.

BY WELL INGTON N. CAMPBELL, M.D.,NEW YORK.

Late House Physician and S urgeon to the 99th street Hos

pi tal late Ambulance S urgeon to Bellevue Hosp itallate Assistan t S an itary Inspector to the board ofHealth ;Attend ing Phys ician to the New York and NorthernDispensari es.

well borne, but yet entirely failed to cure the frac

ture. A very interesting case of the sort i s detailedin part forty-seven ofBraithwa ite’s R etrospect.Celsus, in his eighth book, says If the

fracture is oflong standing,the limb must be ex

tended to create a fresh inj ury,the bones must be

separated by the hand,and the surfaces may be

roughened by rubbing against each other,and if

there be any fatty substance it may be abraded,and

the whole may become as it were recent .”

This plan ofthe Old R oman doctor has been

much too sparingly employed,even down to th e

present time . Some surgeons ofthe presen t dayknow its value

, and generally adopt i t in the treat

ment oftheir cas es but the majority incl ine moreto the high pressure system

,and regard the good

Old plan as too S low and tedious, and though it

may appear so to them ,i t i s certainly

,on th e whole,

by far more rel iable than any other method, when

patiently and properly carried out, having in verymany instances succeeded after all other means had

u tterly failed.

On the morning ofthe 22nd ofDecember, 1 87 7 ,I was called to see W. W. Bingham , aged 53 years,painter

,and found him suffering from a tumor in

his left groin, which ,on examination, proved to be

a strangulated femoral hernia. The patient states

that the rupture first appeared about eighteen

months ago,after l ifting some heavy merchandise

upon a truck ; but he had always been able to

reduce it,by lying in a prone posit ion and perform

ing taxis,up to the 1 2 th ofDecember, 1 87 7 , when,

painting at a he ight that requ ired some effort to

THE CANADA LANCET.

and the fact of strangulation having existed for so

long a time,we though t i t safer to enter it

,when

we found,as we had previously diagnosed

,an

omentum , and was ofa purpl ish colour ; but noThe pro

imbernat’

s

by cutting

d the contents ofthe sacflficulty. Having cleansed

ree interrupted carbol iz edleaving the most pendant

then appl ied a compress

veloped by a spica band

everyhours

2sth .

pulse

removed on the fourth day,and a poultice oflin

seed meal appl ied daily,for three days

,to aid the

suppurative process then renewed the warm-water

dressing with spica bandage,th e l imb being flexed

and retained in that position to rel ieve al l tension .

There were no signs of peritonitis, excep t sl igh t

tympanitis,which , I presume, was due to th e

opium administered,and which readily yielded

to the appl ication ofturpentine stupes appl iedover the abdomen . J anuary 1 3th, 1 8 78,

Wound has healed, and the patien t is walkingabout, feel ing perfectly comfortable. The pecai

liar ities ofth is case,as you will perce ive

, are

as follows

r st. The fact ofi ts being a femoral h ern ia in

the male.z ud . There being no gangrenous condition of

the intestine, even after ten days strangulat ion.

DOUBLE OVAR IOTOMY.

BY A. GROVES , M .D .,FERGUS

, ONT.

In October, 1 8 7 6, Mrs. M .,aged 3 5 and mother

Ofseven ch ildren , consul ted me with reference toan enlargement ofthe '

abdomen,which she had

firs t perce ived several months before . She had no

pain,but noticed that the enlargemen t was steadily

increasing. On examination,I found a tumor of

the l eft ovary, about S ix inches in diameter. As

th e tumor gave very l i ttle trouble,I advis ed that

nothing be done except general tonic treatment.In September last , seeing that the tumor had in?

creased until sh e was stou ter than she had ever

been before her confinemen ts,and that her heal th ’

was giving way, I advised immediate operative procedure, to wh ich sh e consented. On drawing outa little ofthe fluid , i t gave more than two-th irds ofi ts bulk ofalbumen . The operation was arrangedfor the 1 8th ofSeptember, andfor a considerablet ime previou s to that, she took iron in moderate

doses. This seems to me to be a means ofgreatimportance for the prevention oferysipelatousforms ofinflammation, and i t certainly invigoratesthe system and increases the reparative power of"the blood. On the day appointed

,being the tenth

after the cessation ofthe menstrual flow,I proceed

ed to operate inpresence Of Drs . Henderson and

Carter, ofArthur ; Thom and Tamblyn , ofDouglas ,and Orton , Griffi th and Johnson

, ofFergus.

196 THE CANADA LANC ET .

Chloroform was carefully administered by Dr.Thom . An incision about s ix inches in length was

made between the umbil icus and p ubes, and onOpening into the peritoneum the tumor at once

bulged forward. I t was now found that there were

no adhesions,except to the mesentery

,and that

these were easily detached . Having tapped the

tumor with a large trocar and canula,S ixteen pints

ofdark fluid were withdrawn . The sac now easily

sl ipped out ofthe abdomen . A great number ofsmall cysts existed in the wall ofthe paren t cyst, butnone ofthem required puncturing. The ped icle

,

wh ich was long and moderately slender,was t ied in

two parts with a strong hempen ligature,and divi

ded with the ecraseur. The ends ofthe ligatureswere drawn out of the lower angle Ofthewound,and the pedicle dropped back in to the abdomen .

On examining the righ t ovary,a cyst was found in

it about the siz e ofa marbl e , and consequently i twas also removed, the pedicle be ing treated in asimilar manner to that on the left side . After carefully Sponging out the abdominal cavity and insert

ing a rubber drainage tube, the abdominal wound

was brought together by six si lver plated needles,passed so as to include the peritoneum , and woundround with thread in the ordinary figure of8 form.

’

A large compress ofbatting and a bandage completed th e dressing. The patien t was now put to

bed,in one hour from the time she began taking

chloroform,and a hypodermic inj ection Of morphia

given . Six hours afterward, great pain and soreness

qomplain ed of,which was considerably allayed by

hal f a grain ofmorphia. Patien t slept part ofthen ight

,and said she fel t well . On the th ird day

persisten t vomit ing came on , which cont inued unti lth e following morning blood also came from the

vagina,and d id not cease for two days. The case

after th is progressed most favourably. Three ofth en eedles were taken out on the seventh , and the rest

on th e eighth day. On the fourteenth day patien tsat up. O n the 24th ofOctober one Of the ligaturescame away, and between th is time and November

1 8th the remain ing three came away. Since that

time she has remained in the best . possible health

and spiri ts .

'

DR . B IG ELow reports in Toe P r acti tioner a caseOf tetanus caused by a rusty nai l in the foot

,which

was rel ieved in less than th irty minutes by introducing a d rachm of chloral hydrate into the woundafter i t had been enlarged by incision .

TR EATED BY DIA

BY JAMES HAYES , M .D., C .M ., S IMC OE, ONT.

The notes of this case -I had prepared some timeago for publication , but laid them aside, and hadalmost forgotten them until I read the report ofasimilar case in the January number ofthe Lancet .About

'

six o’clock , on the evening ofNovember14th , last, I was summoned by Mrs . B .

, to see her

char-woman,who

,i t was stated

,had accidentally

taken arsenic. Placing a bottle of(Wyeth ’s)Dialysed Iron in my pocket, I proceeded at once

to the house and immediately administered a

powerful emetic to th e patient,and whil e th is was

producing a free evacuation of,the contents ofth e

stomach,I learned the fol lowing particulars

Mrs . B . had purchased a package of arsenious

acid,for the purpose ofdestroying mice, and, thi s

morning,had spread at least half a teaspoonful of

the poison upon a slice ofbread and butter, andplaced i t on a shelf in the pan try. During her

absence from home for a short time, late in the

afternoon,the woman went into th e pantry and

seeing the bread and butter and not being aware

that there was any poison upon it, ate the whole.She afterwards stated She though t i t was rather

gritty . On Mrs . B .

’s return a few minutes after,

the woman complained of being s ick, with cramps

in her stomach,and _wished some ginger tea to

rel ieve them . Mrs . then went to the pantry for

the ginger,when she found the poisoned bread

gone. On asking the woman,Mrs. B . was horrified

to learn that she had eaten it. These were th e'

particulars I l earned after my arrival .

As before stated,I administered th e emetic

and promoted vomiting by large draughts ofwarmwater. After the stomach had been thorough

ly emptied, I gave a tablespoonful Ofdialysediron

,di luted with water

,which was rejected in a

few m inu tes . I then repeated i t in th irty drop

doses every twenty minu tes for two hours, and .

afterwards at longer intervals. About two hours

after my arrival,alarming symptoms of collapse

showed themselves ; th e pulse became extinct at

the wrist the skin cold and clammy, etc . but bygiving brandy freely

,with the appl ication of hot

bottles and friction,she began to revi ve , and went

on gradual ly improving until, in about ten days, sh e

appeared to be restored to her accustomed good

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THE CANADA LANCET.

ABSENCE OF ANUS AND PER INEUM .

To the Ed i tor ofthe CANADA LANCET.S IR - I send you a report ofthe following case

which is interesting ch iefly on account ofi ts anomalousness, and the adaptability of nature to preter

natural anatomical conditions.

On December 30, 1 8 76 , I was called to an obs

tetrical case afew miles away. My patient,Mrs.

C was rather less than medium-siz ed weightabou t 1 00 lbs .

,aged probably 2 2 years

,and

had been married two years . Digital examina

tion revealed a double 03 uteri, with but a single

uterus. These two mouths— or rather what ap

peared to be two, were caused by a portion oftheu terine tissue stretch ing across the otherwise nor

mal os, and thus forming two Openings.

The next discovery was a valvular orifice in the

posterior wal l ofthe vagina. This orifice com

m enced abou t one and a-half inches above the

posterior cornm issure ofth e vulva,and led into a

roomy canal , extending upwards and backwards,and really into the rectum . My patient had

neither anus nor perineum ,and nature not to be

thwarted in her purposes,had institu ted th is new

departure . In this case,then

,we have th e ordi

nary vaginal opening as the channel,through

which mus t pass all faecal matter,in common with

al l other normal d ischarges in connection with the

genito-urinary sys tem ofthe female . With the

above men tioned exceptions,th is woman was well

formed and natural for her siz e in every other

respect. She was del ivered in a reasonable t imeof a fine heal thy child . Afew months after hermarriage she aborted once. From an elder s isterI learned that the above unique condition ofaffairs had existed from birth

,and was consequently

congenital .Yours, &c.

,

W. B. TOWLER.

Wingham , Ont. , Feb . r oth,1 8 78.

ETHER IN SUSPENDED ANIMATION.

To th e Edi tor ofthe CANADA LANCET.

S IR —As the foll owing case may be ofinterestto some ofyour readers

,I send i t for publication

in the LANC ETIn Dec. ’

7 7 I attended Mrs. C aet. 23 , Albany,Ill .

,Feb . sth, 1 878.

7

N . A. POWELL.

primipara. R ecogniz ed a face-anterior

tation , with anterior fontanelle low down1 0 hours labor, pains flagged

,and I th

ether and appl ied th e forceps, the head beingin the middle strait. " After 1 0 or 1 5 minu tes

traction,the delivery was effected. The child d id

not breathe, and so it was placed in a bowl‘

Ofwarm water

,sprinkled on the chest with cold

water,and Sylvester’ s method ofart ificial respira

tion was practised upon it. At the end of1 0minu tes

,estimated time

,th ere was no sign of l ife .

I then caught sight ofmy ether bottle upon the

bed,and Verneuil’s subcu taneous use ofthe drug

in collapse floated across my mind . Havi ng a

hypodermic syringe,I at once inj ected between 3

and 4 minims ofether deep into th e ch ild’sarm . Within a minute the chi ld gasped, and intwo or three minutes i t was breath ing well enough

to enable me to cease the artificial respiration .

We have all seen children suddenly “ come to l ife

from the use ofthe classical means which werefirst used in th is case

,and also from mouth to

mouth insufflation ,a stinging slap on the nates,

&c. Where the respiratory forces should begin at

any moment,i t i s diffi cult to ascribe the exact valu e

to the action ofany stimulus, but in this case itcertainly seemed to me that the child would never

have breathed but for M . Verneuil ’s suggestion .

Should occasion requ i re I propose further to

test the value ofth e procedure. In th is case no

depress ion followed the s timulation , and no local

trouble resulted from the inj ection .

Yours truly

Edgar,Feb . 8th, 1 878.

LAR GE STONE.

To the Edi tor ofthe C ANADA LANC ET.S IR — Ah articl e headed LARGE STONE on

page 1 82, last number ofthe LANC ET, induces me

to send the following

On Jan 26 th 1 87 5 , I removed by lateral operation a stone weighing two ounces and s

’x

from a boy fi fteen years old , but who was remark

ably small ofhis age . R ecovery perfect. If the

stone removed by Dr. Gross, in the art icle referred

to, i s considered unusually large for a boy, whatwil l you th i nk ofthis one ?

Yours truly,D. W. LUNDY.

THE CANADA LANCET.

5mm games.

S OF THE NER VOUS SYSTEM .

v c. E . BROWN-S EQUARD, M .D.

t the last lecture I referred to a

when what we observe is en tirely in Opposition to

exclus ively ofparalysis l imi ted to th e arm ,th e leg

,

and to some ofthe muscles Ofthe face ' There aremany parts ofth e body which escape paralysis inthe immense maj ori ty ofcases of disease ofthebrain . These parts are the muscles ofth e trunk ,the muscles ofthe neck , those muscles which gofrom the trunk to the limbs— the arms or th e l egs.Those muscles escape paralysis more or l ess, rathermore than less

,in the

'

imm ense majority ofcases .Dr. Broadbent has tried to explain th is fact inadmitting that there are certain parts ofour bodywhich depend on a centre located in the medullaoblongata or at the lower part ofthe pons varol i i,and which has the power to act upon both sides ofthe body. So

,admitting that one side of the brain

is des troyed totally,including that nerve centre

body, and thereby the muscles which have escapedparalysis. The view is certainly true in a greatmeasure

,but i t is faul ty in th is Dr. Broadbent, as

wel l as most medical men,considers the corpus

restiformis as a motor-centre. The real ity is,as I

hope to be able to demonstrate, that a smal l partofone side of the brain is suffi cien t for both sidesof the body

,not only for the muscles which escape

par alys is but for the muscles ofthe l imbs as well .

I now pass from th i s to what I have to say regarding th e significance of certain symptoms in th ediagnosis ofthe seat ofthe brain disease whichcauses paralysis. There is one fact, very importantindeedfor you to understand fully before I enterinto detail s upon th is poin t. As you wel l know,th ere are nerves ari sing from the base of the brain

,

nerves which serve as centres,which serve for

general tactile sensibility,and also as nerves of

motion . Then you must make a distinction between cases ofparalysis of those nerves dependentupon disease which strikes at the very place fromwhich those nerves ari se

,in which case the trunks

ofthe n erve itself or its immediate roots within thebase ofthe brain are impl icated

,and those cases

in which these nerves are paralyz ed when th e lesionis beyond the place oftheir entrance into th e bas eofth e brain .

Suppose,for instance, a lesion occurs in the medulla oblongata in the immediate region where theroot of a motor-nerve has its origin ; if th e diseasestrikes there , i t of course destroys some ofthefibres ofth e nerve

,and it destroys th e cells also

from which the nerve-fibres arise. But let thedisease be located in another part of the brain— at

a poin t beyond— where there are no nerve-fibresarising wh ich form a connection with the nervewh ich goes down from the medulla oblongata, then

you will have a result completely different from whatyou have when the cel l i tsel f ofthe motor-root iss truck by the disease. In those cases ofparalysisof nerves in the base ofth e brain dependent upondestruction ofthe cell which gives rise to the nervefibre, or striking the root i tsel f before i t reachesthese cells

, you have j ust th e same resul t producedas i f the nerve-trunk had been affected outside th ebrain .

Someth ing quite d ifferent takes place when thedisease i s beyond the origin of these nerve-fibres .

In what I have already said in a previous l ecturewi th reference to paralysi s of the muscles of theface

,muscles ofthe eye, paralysis in the tongue, in

the neck,and elsewhere, I had in view only those

cases in which the paralysis depended upon diseaseins ide ofthat z one or layer ofnerve-cells wh ichgave rise to the motor n erve~fibres going to thetongue, to the eye, etc. There is no question that

,

when you find disease in the base ofthe brainstriking the nerve or its roots before they reach thecells of origin , there wil l be paralys is upon th esame S ide of the body in which the disease is situated .

It is quite ev ident that i t must be so . You havea cau se acting the same as if you had d ivided thenerve itsel f outside of the brain

,and ofcourse you

have paralys is of th e nerve.In what I have now to say, you will find that

what I have j us t mentioned is of the greatest importance I will i llustrate at once the mean ing ofthis. You wil l see that in cas e of disease ofth epons varol ii

,for instance, a l ittle above th e place of

200

origin Of the faci al nerve— the nerve which actsupon the muscles wh ich give expression to theface—there is a characteris tic condition produced.

I f the disease is upon the roots ofthe facialnerve , or upon the cells which give origin to thesefibres ofthe facial nerve

,the muscles ofthe face

upon the same side ofthe seat ofthe d isease wil lbe affected. I f the dieease is elsewhere as a rule

,

the muscles ofthe face upon the side opposite tothe seat ofthe disease w il l be affected. So yousee that in d isease in the same organ

,the pons

varol ii, you may have resul ts j ust the reverse ofeach other. The face may be paralyz ed upon theright or upon the left S ide but as regards the l imbs

,

as a rule, you will find them paralyz ed upon theside oppos ite to the seat of the les ion . What Iwish you now to fully appreciate i s the fact that

,

when the d isease strikes at the origin Ofthe nerves,

necessarily i t produces paralysis in the nerve thatn erve may be the olfactory

,the Optic

, or any oneofthe cranial nerves . In any ofthese cases th every same th ing w il l occur with regard to the seatofthe paralysis ; i t wil l always be upon the sames ide with the lesion .

D IAGNOS I S OFHEM IPLEGIA.

I come‘

now to the diagnosis ofvarious cases Ofhemiplegia. I must firs t po int ou t the fact thatd isease ofon e-half of the spinal cord

,as well as

disease at the base Of the brain,can produce

hemiplegia, and how you are to determine wh ereth e seat ofthe d isease is

,i s what I wil l try to ex

plain . You may find two persons struck downsuddenly with loss ofconsciousness

,sometimes

with convulsions— convulsion s are not essential,

however— and after there is recoveryfrom the Shock ,youfi nd that there is paralysis

,in both cases

,on

on e side of the body. We will suppose that theright s id e is paralyz ed. One ofthese personsmakes grimaces upon the side ofthe face corresponding with the side on which there is paralys is oftheextremities so you may be incl ined to think thatthere is paralysis ofth eface upon the opposi te side .

NEW PO INT IN D IAGNOS I S .

This poin t in diagnosis,so far as I know

,has n ot

been mentioned except by myself,and as i t is a

constant phenomenon in certain kinds ofles ion ofthe sp inal cord

,I wish you to be quite aware that

in that case there is merely an appearance ofparalys is upon the side ofthe face opposite to that onwhich there is paralys is of the l imb. I f youpay attention only to the appearance ofparalysis ofthe left s ide ofth e face and on the right s ide ofthebody, and establish thefact that the man has hadan attack ofapoplexy

,loss of consciousness , etc.

,

you wil l certainly. and qu i te naturally, according tothe teachings of sc ience unt il n ow ,

be led to admi tthat there has been somewhere in the bra in a lesion

THE CANADA LANCET.

may be a mistake,or i t may be correct ; because

lesion in on e-half ofthe spinal cord near the medulla oblongata can produce all these symptoms.I wil l say at once that when you examine the face,you will find that the side which seems to be paralyz ed is not the paralyz ed side. You will findthat there is no paralys is ofthe face upon eithers ide in that case. You will find that the appearance of paralysis comes only from the fact that , onthe s ide of the les ion in the spinal cord , there issimply a spasmodic state of certain muscles of theface.In case ofspinal hemiplegia, paralysis ofone

side ofthe body, depending upon disease h igh up,and l imited to one-half ofthe spinal cord, you willfind that there is a series of symptoms such as Imentioned a moment ago . You wi l l find featureswh ich certainly will distinguish these cases fromcases ofhemiplegia, depending upon d isease of thebrain . If you examine the patient carefully, youfind that there is paralysis

,and; as I have supposed

the les ion to be In the righ t half of the cord, thepatien t is paralyz ed In the right l imbs ; but there isno d iminution ofsensibil ity. On the contrary, thereis cons iderable increase ofsens ibil ity, as measuredby the esthesiometer. The hyperaesthesia may beextremely great. Indeed

,in the case of0ne ~

ofmydear friends

,Mr. Charles Sumner, at the two po ints

in the spine which had b een inj ured by a cane inan assault made upon him in th e S enateC hamber,both points ofth e instrument could be distinctlyrecogniz ed

,no matter how near to each other they

were placed.

That kind offeel ing— that oftouch— may be increased cons iderably i n many other cases ; but insp inal hemiplegia the tactil e sensibil i ty is increasedin the paralyz ed limits to a considerable extent.O ther kinds of feel ing are also increased. Pain

ful feeling is often considerably increased, andsometimes it is so great that a mere touch producesa scream . There 13 also an increase in the powerofdetecting differences oftemperature. There ISlack ofpower ofenduring the contact ofanyth ingvery cold

, or very hot, as these th ings will producedecided pain . There is bes ides an increasedsensitiveness to tickling. But there is anotherfeature which wil l assis t in mak ing a diagnosisbetween this form of paralysis and that form dependent upon d isease i n the base ofthe brain , andthat is the condition ofthe muscular sense . Whenthe pat ient has but l ittl e power of motion themuscular sense is very good indeed

,and he will

know perfectly well where his l imb is without thenecessi ty ofplacing the hand upon i t to determinei ts locat ion .

Now,in the contrasting condition

,there is loss

of sens ib il i ty ofall kinds. The loss may be ab

solu tely complete, so that the patien t is not able tofeel any blow

,prick

,tick ling, gal van ism , c

‘

c .

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202 THE CANADA LANC ET.

One Of the chief effects produced by lesion in thepons varoli i in man is cons iderable congestion ofthe lungs . Another effect, which depends almostonly upon les ion in the pons varol i i where the cruscerebri comes into i t, i s hemorrhage in to the lungs.This occurs very frequently indeed ; som etimes i tis sl igh t

,and sometimes enough to destroy l ife

rapidly. I t was known that hemorrhage into thelungs occurred in connection with hemorrhage in tothe base ofthe brain , but i t had been supposedthat it took place because of the same al teration inthe walls ofthe blood-vessels in the lungs as waspresen t in the blood-vessels in the brain . Myfriend Professor Charcot and Bouillaud made thegreat discovery that hemorrhage in the brain depended almost always upon the rupture of smallaneurisms— m il iary aneurisms. I t was imagined ,and it has been found to be the case

,that the blood

vessels in the l ungs al so have th e same kind ofan eurismal d ilatat ions, and it was though t that inthose cases in which hemorrhage

,either small or

large,took place in the lungs, after hav ing hemorr

hage into the brain,i t was dependent upon the

same cause. Without doubt it is so in some cases,

bu t,as a rule

,when the hemorrhage in the lungs

appears very qu ickly after that which occurs in thebrain

,i t is produced in a direct manner by an al ter

ation in the circulation in the lungs .I have asserted that the breaking ofblood-vessel s

in the lungs depends upon th is chan ge . Thearteri es and veins become so contracted that therei s not a trace ofblood in them ,

and then the con

gestion goes so far that a capillary breaks, and thereis hemorrhage . I t is one ofthe causes ofdeath indisease in the pons varol ii, or perhaps at other partsofthe base ofthe brain .

This cause ofdeath has not been suffi cientlyguarded . against

,an d it very frequently happens

that no examination of the chest is made in thesecases. This is a fault which I myself have falleninto

,bu t i t should always be kept in m ind that

gr eat al teration can take place in the lungs inconsequence ofdisease in the base ofthe brain .

The opposite may occur, perhaps, in one out often cases .We have

,then

,fi rrf, congestion ofth e lungs, and ,after a time

,there may occur

,foci ofinflammation

in connection with acute disease in the base of thebrain . AS the patien t has more or less diffi culty ofbi'

hath ing, on account ofth e brain disease i tself,

the disease ofthe lungs passes unnoticed,and no

local treatment is appl ied which could be Ofgreatservice to the patient. I have no doubt that wemay recall to memory a great many cases publ ishedas fatal cases ofd isease

,occurring at the base of

th e brain,wh ich term inated fatally

,not because of

th e brain disease itsel f,but because ofsubsequent

disease ofthe lungs, which passed unnoti ced duringl ife.

There i s , therefore, in cases of disease ofth e

longata. And you know that if this nerve isgalvaniz ed, the heart

’s action is arrested. Well,

acute disease in the medulla oblongata,or close to

i t in the pons varol ii,will produce irritat ion ofthe

par I agum ,and may reduce the heart’s action to

such an extent as to prove fatal . You doubtlessknow that there are a number ofcases upon recordin which death was caused by pressure upon themedulla oblongata

,from displacement ofbones,

or some other cause. There is th is feature, then ,in connect ion with disease in that region thati s,there is a diminution in the beat ofthe heart

a diminution in force rather than a diminution inspeed.

There are other features belonging to lesion inthose parts. As you well know, the oesophagus ,the pharynx

,and the larynx are suppl ied with

nerves which arise from th is region. There maybe spasm in these organs. In a case which I shal lalways remember

,for i t occurred in the person of

a most dear friend ofmine,there was such a spasm

in the oesophagus that i t was absolutely imposs ibleto feed him by the mouth not even a tube couldbe passed through the oesophagus, so great was thespasm , and ,

we were obl iged to sustain his l ife bynutrit ious inj ections in to the bowels. The materialu sed was the fresh pancreas ofan animal , withhashed meat. The fat is removed from a fresh pancreas

,and the influence of th e remaining portion

upon nutrition is pretty nearly the same as ifaS eries ofmeals were taken in the u sual manner. Inth e case ofmy poor friend, l ife was maintainedeigh t days solely by this process of eating.

There 15,therefore

,an effect produced upon these

parts by disease s ituated at the base ofthe brain ,as mentioned. There are other features ofinterest.You may diagnose very easily,for instance, Whetherthere is disease present upon the origin ofthetrigem inus nerve by change in th e state ofthecornea. The cornea becomes somewhat inflamedand after a time the eye may be destroyed. You

already know that Magendie has lOng ago shownthat when the trigeminus i s divided In an animalthere will fol low impai rment ofnutrition in theeye,and after a time the organ will be lost. Magend iealso has shown that all the senses are affected bydivision of the trigeminus— the sense ofsight, ofaudition

,Of olfaction

,as well as the sense oftaste.

Th is conclusion ofMagend ie would not have beendrawn had he been famil iar with the phenomenonofthe loss offunction. When the trigeminus isdiseased or divided, the nerve-fibres produce noaction

,and that resul t is qu i te sufficient to produce

loss ofsensation , and the nutrition ofother organsof sense is d isturbed by such resul t.A blow upon the frontal nerve,for instance, may

THE CANADA LANCET.

You will find that there is,i nstead ofparalys is of

the l imbs, anaesthes ia or a great deal ofhyperwsthesia.

ABS ENC E OFC ONVULS IONS IN D I S EAS E OFTHEPONS VAROL I I .

ofdiagnosisIn a case Iparalysis ofluded , theren s varol i i inoncluded sothe changesave j ust de

scribed. The patien t d ied subsequently,and Dr.

Edes, of Baltimore, found the les ion at the exactpoint at wh ich i t was thought to b e s ituated . Therewas no special maturity in making th e d iagnosis

,

but I mention the fact s imply to Show that you mayfind d isease upon one-half of the pons varoli i producing upon the same side paralys i s ofmotion andchanges affecting th e sensat ion and nutrit ion of theeye, upon the same S ide. But (115 6 815 6 at the same D IAGNOS IS OFD I S EAS E OFTHE C RUS C EREBELLUM .

poin t can produce j us t the reverse,and we may

have paralysis upon the oppos i te side,anaesthesia

upon the oppos i te s ide, and rigidity of the muscles .So you may have paralysis upon the same side withthe les ion

,or paralys is upon the Opposite side. I

wil l add that you may have motion lessened III thatpart, with clear symptoms belonging to the trigem inus, without paralysis in the trunk or in the l imbsThere Is in th is las t case

,perhaps

,some diffi culty In

diagnosis . You may th ink that the tri gem inusalone i f affected , but it is not necessarily so ; fora great part ofth e pons varol i i may be destroyedwithout producing paralysis

,except in the nerves

which ar i se from that region ofthe brain . Thosenerves have been most aflected

,bu t In some cases

,

Stanley,a tumor had

ons varolii,and there

s upon the correspond

would have been clear,Inus was affected com

which is not rare in conthe trigeminus

,and that

There is, therefore , no5 ofd isease affecting theseIt wil l find very frequentlyat the base ofthe brain.

You wil l also find that there i s a remarkable ahsence ofsymptoms. The pons varol i i has beenconsidered as a part perfectly able to produce convuls ion s. I t is so in animals

,and convulsions are

read ily produced by irritating that part ofth e brain ;but it is not so in man . Disease there producesconvuls ions less frequently than disease el sewherein the brain . So if you find that convulsions arenot present, and there are symptoms showing thatthe nerves arising from this part ofthe brain areaffected, you will almost certainly be led to admi tthat there is disease at that poin t. There is a partclose to the pons varoli i which may give rise tomost interesting features , and indeed it is not rarethat disease in th e pons varol i i produces some ofth ese symptoms. I t is that part wh ich is close tothe edge and unites the pons varoli i with the cerebel lum, the crus cerebellum . When th is part i sirritated , a rotary movement of th e body is produced . I t is no t S pecial to irritation Of that part

,

however, but irritation of the crus cerebrum andother parts ofthe brain may produce the same kindofmovemen t.

Diagnosis ofdisease ofth e crus cerebellum aloneis usually very easy. Hemiplegia depending upondisease ofth e crus cerebellum may appear uponthe same side or upon the opposite s ide of the body.As a rule

,i t appears upon the opposite s ide. But

there are two cases ou t ofth e entire number,which

is not large, ofdisease ofthe crus ‘cerebel lum

,in

which paralys is was present upon the same side .The crus cerebellum has been considered as th epo int ofunion ofthose parts ofthe brain whichproduce voluntary movements with those partswhich produce sensation . S O you see that in caseofdisease ofone crus cerebellum you should havealways complete paralysis ofmovement

,and com

p lete anaesthesia upon the opposite s ide of the body.This is absolu tely false . Out ofsome thirteencases ofth is kind upon record , complete paralys is isno t at all frequent, and cases ofcomplete anecsthes ia are very rare— indeed , I know of only twosuch cases. The facts

,then , are not in harmony

with th e theory that the crus cerebellum is a partconta ining al l the motor and sensitive fibres go ingto the Opp osite s ide ofthe body. So l ittle is thattrue that there are cases in which destruction ofthe crus cerebellum has occurred without paralys i sat all . Certainly

,there are ten cases on record in

which the enti re mass ofthe crus cerebellum has

THE CANADA LANC ET.

been destroyed without producing paralysis uponthe opposite side

,and withoutproducing anaesthesia.

I have said paralysis in some of these cases seemednot to exist at all

,but i t is quite an essential matter

that,in the future

,more reliable means are em

ployed to ascertain whether paralys is is present ornot, than those wh ich are usually employed .

PARALYS IS A C ONSTANT SYMPTOM OFBRAIND I S EAS E.

If you see a man walk about, see that h e is ableto stand firmly upon his legs

,and that he grasps

with both hands firmly,etc.

, you are at once inclin ed to th ink that there i s no paralysis . I mu stsay that

,although th ere are many cases ofd isease

ofth e brain in which there i s not marked paralys is,my bel iefi s that, in every form or kind ofbraindisease

,were we in th e habit ofstudying the patien t

more carefully, we should have a great chance offind ing some degree ofparalys is .

Most ofthe instruments employed for this purpose are exceedingly d efective .

[A descript ion ofan instrument was given . Theinven tor i s one ofth e Professor’s friends . I t givesa very clear measure ofth e strength ofthe legs

,

and i t can be used to measure the strength ofanypart ofthe body ]I do not th inkthat we can find the exact strength

a patient who has the brain d isease possesses,n u

l ess i t i s measured by some rel iable instrumen t.When I say that sometimes d i sease almost entirelydestroys on e corpus cerebellum

,or any other part

ofthe brain , without the product ion ofanaesthes iaor paralys is, I only mean that so far as the caseshave been recorded , no paralysis have been noticed ,but I suspect that some degree ofparalysis waspresent — M erl . R ecor d .

INJUR IES OF THE HEAD .

BY JOHN ER I C ER IC H S EN , F.R C .s .,

EXTRAVASATION OFBLOOD ON THE DU RAMATER , &c.

GENTLEMEN,— I wish to direct your attention toa pecul iar class ofcases

,wh ich is amongs t the most

in teresting Of those that are connected with inju riesofthe head, both in th e pecul iari ty of the symptomsan d ‘ th e accuracy with which the d iagnos is can bemade, and in which you can give absolute rel ief tothe pat ien t— I mean those cases in which there i san extravasation ofblood between the s kul l an ddura mater. They are a class ofcases that engagedthe attent ion ofsurgeons very many years ago.

This subject attracted_th e attent ion of

,and was

very closely invest igated by, su rgeons ofa pastgeneration . You w il l find that we have really atthe presen t day been able to add very l ittle to theinformation that can be obtained from the memoirs

find in their writings much valuable information onall subj ects connected with head injuries , and Icannot but fear that the study Ofthe works of thesegreat surgeons is too much neglected at the presen tt ime. But before I proceed to discuss these extravasation s , let me relate a few cases which are interes ting

,amongst other reasons as showing what very

sl igh t injury may occasion a fatal “

extravasation .

Some years ago a little girl was going down stairswith her mother to dinner. She said

,I wil l go

first mamma, and started to run down stairs, butshe m i ssed her footing and fell forward . Strikingher head sl ightly against the wall

,she fel t a l ittl e

daz ed at the time,but wen t to h er dinner

,ate it

,

and afterwards fel t sl ightly S ick. She was sent tobed

,slept soundly

,and was dead next morning.

There was a d ot found between the dura mater andthe skul l on the S ide ofth e head that had beenstruck

,but without any fracture .

Many years ago I was called to see a ladywhohad come up to town for a few days to amuse herself. She went to the opera

,and in going down

the Stairs caugh t herfoot i n the train of a lady ’sdress. She fel lforward and struck her head sl igh t lyagainst the opposite wall . She fel t a littl e giddy

,

and said that She would not go into the theatre,that she would return home . She went to bed

,fell

asleep,and about ten in the morn ing

,when the

maid came to wake her,she found her so fast asleep

that she d id not l ike to disturb her ; but abouttwelve o ’clock the friends got alarmed

,and they

sen tfor a n eighbouring medical man,and he came

for me . I found her comatose , suffering from com

pression ofthe brain,and went home to get my

treph ines , bu t when I came back she was dead. A

post-mortem exam ination was made,and we found

a clot of blood the siz e ofa small saucer on the sidethat was struck

,between the skul l and dura mater

over the course ofthe m iddle meningeal artery, bu t‘

withou t any fracture ofth e Skull .Some years ago a cabman was thrown offh is box,

and h e became slowly comatose. Three days afterthe acciden t he was brought to the hospital . WhenI saw h im he was suffering from profound coma,and there was some paralys is of the side oppositeto that on which he had been struck . I cut downupon the skull

,and found a starred fracture in the

right temporal bone . I trephined him,and found

a large clot ofblood under the bone. Some bloodwelled ou t rather freely

,evidently from the middle

meningeal artery. The flaps ofscalp were laiddown

,and he mad e a very good recovery. Dur

ing h is convalescence he presented one ofthosepecul iar psychological phenomena I mentioned ina former lecture. He commenced to swear like atrooper.” Some four or five years after th is, on e

'

day, as I was going home, a cabman came up,touched h is hat to me

,and said

,Do you recollect

https://www.forgottenbooks.com/join

THE CANADA LANCET.

th efracture. Well,here is a typ ical case, then— as

typical a case as i t is possibl e to have,— ofa wound

ofthe middle meningeal artery giving rise to extravasation ofblood . Ju st let me

,

go over what tookplace .

In the fi rst place,the man received a blowfrom

fall ing offhis box. He was concussed,but he com

pletely recovered his concussion so much so as tobe enabled to drive

,and that shows that he was

completely free from paralysi s . After having drivensome l ittle distance

,he fel t giddy

,and resigned the

reins to h is companion,lay down in the bottom of

the van , and gradually became comatose. He wasbrough t to the hospital , and found in a state ofprofound coma w idely dilated pupils and slow pulse- in fact, he was exactly in _

th e condition ofa manwith atheroma of the arteries ofthe brain

,one of

which had given way and occasioned fatal apoplexy.

The trephine was applied to the left temporalfossa. Now, why was i t applied to the left temporal fossa PFor this reason becau se it was morebulging than the righ t . And why was it more bulging than th e right ? Because there was a fissurethrough wh ich blood was ooz ing

,and had given rise

to the proj ection ofth e temporal muscl e. The treph ine was appl ied, and i t was applied in the courseofth e middle men ingeal artery. Now

,gentlemen

,

ifany ofyou were asked th e question elsewhere,How would you apply the trephine so as to strikethe middle men ingeal artery P you would give th isanswer you would take a point an inch and a halfabove the zygoma, and an inch and a half behindthe external angular process ofthe frontal bone

,and

where these two po ints meet you will find themiddle men ingeal artery.A large clot was exposed and when you expose

a large clot, what are you to do ? Leave it or

remove i t The better plan wil l be to remove it .Sometimes the brain wil l upheave and push ou t

the clot but somet imes it does not upheave . Inth is case th e brain d id not upheave

,and the man

d ied speedily comatosed . You should remove theclot, and, having removed the clot, what do youdo with the middle meningeal artery ? I f it istorn , as in th is case , you cannot stop the haemorrhage ; and there is no necessity to do so ; youwill find the haemorrhage cease ofi tself. There isa very curious cond ition connected with th is m iddlemeningeal artery

,and it is th is when i t is wounded

in such a place,and is exposed

,i t bleeds a littl e

,

but it does not bleed per saltzem the blood merelywells out from i t, and the haemorrhage very soonceases. Probably the artery contracts but in th iscase i t did not do so

,because th e artery was only

partial ly d ivided i t could not contract and retract.Now th ese are some ofthe ch ief points in con

n exion with these cases but there are on e or twoothers to which I have to direct your attention .

One is,the siz e ofthese clots they are very large .

This one, after it had been removed, weighed three

ounces and-a half. The largest I havesomewhere about four ounces and a half.very th ick in the middle

,and flattened

edges. Usually they are black,and th

l ittle serum in connexion with them .

dura mater was found to be separated to a considerable extent. The man did not l ive many hours afterthe accident

,and this large clot was extravasated

after an hour or'

so. This l eads me to a brief discuss ion on the causes ofhaemorrhage on the duramater

,and the cau se ofthe separation ofth e dura

mater from the skull . I need scarcely tel l you thatthe dura mater is the internal periosteum ,

so to

speak,that upon the dura mater the vessel s that

supply the cranium ramify,and that the dura mater

i s very closely appl ied to the skul l. In post-mortemexamination you will find that you have to tear thedura mater from the skull

,i t i s so closely adherent

to th e bone that l ies immediately upon it. Thishas a very distinct bearing upon th e cause oftheseextravasations ofblood . They are very commonlyattributed to rupture ofth e middle meningeal artery,and

,in some cases

,with justice. But there are

cases in wh ich you get these symptoms without anylaceration ofthe middle meningeal artery. Thevessel

,after death

,is found lying uninj ured in its

osseous canal.The explanation ofthese cases given by Sir

Charles Bell many years ago showed experimentallyhow th ese extravasations are occasioned. He tooka wooden mallet and struck a forcible blow uponthe side ofthe h ead ofa body in the dead-house.On removing the skull-cap he found that the duramater was detached from the seat ofthe blow,

al

though th ere was no fracture . He went furth erthan th is

,he made the same experiment upon ano

ther subj ect,and after having made i t he inj ected

i t with soft siz e . He injected this into the arteries ,and found

,after the siz e had been allowed to cool ,

that it had b ecome extravasated, and had formed alarge clot between the dura mater and the skull .There you get the exact cond i tion ofth ings thatwe meet with in the wards and operat ing theatre

-name]y,a separation between the dura mater and

the skull,and an extravasat ion of blood between

the dura mater and skul l where they are separated.

From these interesting observat ions i t would appearthat there are two d istinct sources of haemorrhagebetween the dura mater and skull . In thefi rst casethe middle meningeal artery is torn across by afracture travel ling across the anteri or inferior angleof the parietal bone ; and in the second case, inwhich the artery is not torn , but an accumulat iontakes place from the smaller branches that get tornat the time the shak ing occurs which separates th edura mater from the skull

,and wh ich al lows ooz ing

to go on,and produces a slow supervention of coma

—what you may call “ surgical apoplexy.” I t has

THE CANADA LANCET.

ater was the primary condi tion andth ink , be l ittle doubt that the detachdura mater i s th e resu l t of the blow on

d th e fi l l ing is the consequence ofthatand that i t could not take place if the

‘detachment had previously occured . The vacan tplace gradually gets fi lled up with blood

,more

rapidly ifth e trunk ofth e middl e meningeal arterybe torn across , when i t wil l become full in th ecourse of half or three-quarters of an hour after theaccident. When th e main trunk escapes

,and it i s

only the terminal branches that get torn, you get

that se t ofcas es in which the accumulation ofbloodmore slowly

,and only compresses the

an extent as to give ri se to coma inseveral hours .

is a th ird cond ition,and that th ird

very important one. I will relate on ef another. Last

spring I was called to see a gentleman l iving a fewmiles from town , who was out riding with hisdaughters when h is horse p icked up a stone . Helet his daughters go on ,

and got down to see whatwas th e matter

,but finding that their father did notfollow th em the young ladies re turned , and found

him lying on the ground in a state ofinsensibil i ty.The

_ precise nature of th e acciden t did not transp ire, but it i s probable that the horse turned itshead and struck h im when he was trying to removethe stone . Anyway he was seen and attended toimmediately after the accident 5 not more than twoor three minutes could have elapsed

,but yet abun

dant haemorrhage had occured . There was a largepool ofblood in the road

,and blood was well ing

freely ou t of h is left ear. The daughter took hi shead on her lap

,and her habit was soon saturated

wi th blood. Some assistance was got from a neighb'

ouring cottage , the bleed ing ceased, and in thecourse of an hour or so he was able to walk to aneighbouring railway station

,took a trainfor some

m iles , and afterwards walked from the station home,a distance ofabout a quater ofa mile. There wasno question abou t th e quantity ofbl ood that hadbeen lost, because the young lady

’s habit was soakedthrough and through

,and a large quantity lay in

the road as wel l . I saw him the same even ing.

He was somewhat concussed,but had no paralysis

,

no coma, no dilatation of pu pil s, and no s igns ofintracranial extravasation or compression . Thebleeding from the ear had ceas ed , and he thoughtthere was noth ing much th e matter with h im . Heremained very quiet under my care and that of Mr.

Evans, ofHamstead, for some weeks . He made aslow recovery

,but apparently a very good one, the

only trouble l eft being deafness of the ear on theinj ured side . At the end ofa couple ofmonth sor so h e was able to go to the city

,against our ad

vice, however, but he did do so on some businessmatters ofimportance. He now gradually becamemelanchol ic, and got rel igious delus ions . I t wasthough t that a change ofair would be of advantage,and he went to Scotland with his brother

,and in

about a week he suddenly got worse , had someepileptic sei z ure

,and died in a very short t ime .

There was,unfortunately

,no post-mortem ex

aminat ion in th is case,so that we could only guess

at the source ofth e sudden and copious haemorrhage. But in th e next case which I shall relatethere was a post-mortem

,and in al l probabil ity the

post-mortem in th is case throws some l igh t on th eone j ust given . I wil l read i t to you as reported inth e case-book

,and from Mr. Beck’s n otes.

On Aug. 1 6th,W . P aged abou t th irty-two,

received a severe blow on th e l eft side ofth e h eadfrom some bars ofi ron proj ecting beyond a railwaytruck. On admission he was unconsciou s

,bu t

struggled when the wound was examined. Thewound was about two inches in length and i rregular in shape

,and situated abou t two inches and a

half above the left mastoid process . On examination with the finger

,a large piece of bone could be

fel t to be deeply depressed,th e upper part being

depressed below the lower. A small loose fragmen t could be seen . This was removed with apair of forceps

,and sufficient room was so obtained

to insert an elevator beneath the depressed fragment. The moment it was raised

,a stream of

blood about as th ick as the top of a finger,and

ris ing to the heigh t ofabou t three-quarters of aninch

,poured ou t ofthe wound . The depressed

fragment was immediately seiz ed in a pair ofsequestrum forceps

,and pulled out. I t was about

two inches and a halt i n length by one inch and ahal f in breadth it included the lower and posterior part ofthe parietal bone, but the groove for th elateral s inus was not included . I ts surface wascovered in part by the fibres ofthe temporal muscle.I t was n ow seen that the blood came from underthe lower margin ofsound bone

,and

,in order to

arrest i t,plugs of l in t had to be pushed in between the

dura matter and the bone. From the s ituation of thefracture with relation to the lateral sinus

,i t was evi

den t that the depressed fragment had been drivendownwards and inwards

,and its point had lacerated

the sinus , but was partially plugging the wound i thad made. On rais ing the fragment, the bloodburs t ou t th rough the wound. The fracture wasj ust above th e sinus, and the depressed fragmentwas driven downwards, and inwards into i t. Theplugs ofl in t inserted in order to stop the bleed inglay in the same position

,and instead ofpressing to

gether the two sides of the sinus,they propped th e

THE CANADA LANCET.

wound open and proj ected actually into the cavityofth e s inus, a condition almost absolutely certainto cause decompos ition and breaking down ofanyclot that m ight form

,and so give rise to sept ic em

bol ia and pyaem ia.

If the surgeon in charge could possibly have fullycomprehended the situation , the proper l ine ofpraet ice would probably have been to cut away thebone wi th the trephine or Hey’s saw till th e s inuswas brought fully into v iew, and then to apply direct pressure . This operation might have been easily performed while the plugs '

were arrest ing thehaemorrhage. But such minute d iagnosis 1s impossible . O n the fourth day the temperature rose to

and he had a rigor. On th e fi fth day theplugs were removed

,bu t the blood poured ou t just as

at first The plugs were immediately re appl ied. Onthe same day convulsions commenced. They began by twi tch ing ofth e right side of the face andturn ing ofthe head to the right side thenthe r ight arm twitched, then the right leg,and finally the righ t arm . At th is t ime therewas some eviden t want of power in the rights ide

,bu t this disappeared in afew days . He

had become more conscious, and seemed toknow h is name when spoken to. On the s ixthday he had twenty-seven convuls ions . Temperature rose to 1 04 and he had another r i

gor. The convuls ions continued t il l the eleventhday

,when they ceased . He had then regained

consciousness to a great extent, knew his wife ,and could answer questions . On the tenth dayanother attempt was made to remove the plugs,and the greater part was got away, but on trying toremove the deeper part haemorrhage again com

m en ced , bu t ceased at once on applying a new padover the remnant of the old on e. On the fifteenthday the plugs were successfully removed. Thesymptoms of pyaemia were, however, now well marked

,and the pat i ent ultimately d ied ofth is d isease

on th e 3 r st day. A few days before death , a largeabscess formed in the neck below the masto id process

,on squeez ing which , pus could be made to

pour out from the hole 1n the skull .

The post-mortem showed the condit ions aboved escribed in the bone and sinus . The sinus wasnot firmly occluded , being fi lled on each s ide bysoft decolorised putrid clots . This condi tion ‘

ofthrombosis and decompos ition ofthe thrombus hadextended into the mastoid vein and through themastoid foramen

,and it was th is that had caused

the abscess in the neck , on squeez ing which th e pusfound its way by the mastoid foramen into th e lateral sinus, and from that through the open ing in it intothe wound in the h ead from which i t flowed . Therest of the post-mortem was characteristic ofthepure embol ic form ofpyaemia . Every organ ofthebody was typically healthy, excep t the lungs,which were riddled w ith secondary abscesses, ev1

d en tly ofembol ic origin .

the usual swell ing found after death with hightemperature.Now here was a case

,then

, ofextensive intracranial haemorrhage, not from an artery but froma s inus - one ofth e venous sinuses

,and you can

eas ily conceive that if there had not been a veryfree outlet to th is blood it might readily have accumulated within the cran ium

,and you would have

had compression ofthe brain from venous blood ,as you got i t in the other case from arterial blood .

You got in th is case that pecul iar train ofsymptoms that u sed to puz z l e the older surgeons —namely, the occu rrence ofpyaemia, an d the tendency tosecondary depos i ts, especially in the l iver. Therewas no doubt ofthe pyaemia in th is case

,and it

was due to the large wound ofthis venous s inus,

and the consequence of a plug which could not beremoved

,l eading to general blood-poison ing.

There is only one po int more that I wi ll speakabout to day, and i t is that these cases ofblows onthe side ofthe head with detachment ofthe duramater seem also to explain the occurrence ofintracran ial suppuration . I t has been well-known tosurgeons that after blows on th e side ofthe headwithout fracture an abscess will form between thecran ium and the dura mater. That abscess no

doubt forms j us t as th e clot does in the vacantspace between the cranium and the detached partofthe dura mater

,but in order that it may form

something more is necessary than the mere detachmen t of the dura mater— the mere detachment ofthe dura mater wil l not give rise to abscess. Theseabscesses only form if the portion of skul l whichhas been struck loses i ts vital i ty

,j ust as we get

acute subperiosteal abscess on the tibia ofa ch i ld.

The stripping offofthe dura mater,wh ich is the

chief organ of supply ofblood to the cranium,is

not, however, sufficient, because the cranium re

ceives blood through the anastomoses ofthe diploe,

and also receives blood from vessels that take theirorigin from the exterior ofthe skull . In order thatabscesses should form you mus t

'have th e periosteum stripped oil , and you have this stripped offatthe same t ime that the dura mater i s detached .

You will have th e vascular supply ofthe bone soseriously interfered with

,both from w i th in and from

without,that i t loses i ts vi tal ity

,and thus

,l i ke al l

necrosed bone, becomes a source ofirritat ion andofabscess — T/ze Lancet.

THE BLOOD IN D I PHTHER IA.— MM . Bouchut

and Dubrisay communicated to the Paris AcademyScience (London M ed . R ecord ) the results of theti nting ofthe blood-corpuscles in diph theria. The

numerat ions were made by Hayem ’s process andthe wr i ter proved that in diphtheritic angina thenumber of whi te corpuscles is cons iderably augmen ted

,wh i ls t that ofthe red corpuscles is d im in

ished . The increase of the white corpuscles variesThe k idneys presented d irectly with the gravity ofthe disease — C li n ic.

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21 THE CANADA LANCET.

ed,but there was still pain in the belly

,which was

rather tympanitic. On the 1 2th th e tenderness ofthe belly had passed away, and the opium pills wereom i tted. The patient continued from th is t ime todo well . On the z r st, twelve days after the operation

,the wound was quite healed . A truss was

ordered,and on th e 3oth the man left the

hospital .CAS E 3 . S trangnlatea

’

oéligae inguinal bern ia opcration nai l /tout open ing (125 sac ” covery .

— EdwardW aged twenty-three, a porter, was admittedon Dec. 4th last suffering from a strangulated ob

l ique ingu inal hernia ofthe righ t side. He wasruptured last Easter for the first time whils t l iftinga heavy we igh t. He had worn a truss ever since .On the morning ofhis admiss ion

,at about 6 A.M . ,

whilst coughing, th e hernia again came down , andhe was unable to reduce i t. Feel ing sick

,and

having pain in his belly, he appl ied to the hospital ,and was admitted at about 8 o ’clock

,two hours af

ter the descent of th e rupture. Ice was appl iedover the tumour, opium given by the mouth , andthe taxis was tried

,but wi thout success. As th e

symptoms were not urgent,this treatment was con

t inned unti l 2 o’clock,when Mr

.Lawson saw th e

man . By th is t ime undoubted symptoms ofstrangulation had se t in ; there was then a tense irreducible inguinal hern ia fi l l ing th e righ t side of thescrotum . There was dragging pain in the abdomen ,extending downwards from the umbil icus

,together

with regurgitant vomiting ofdark-green bil io usmatter.As the symptoms were now becoming urgent,

Mr. Lawson decided to place th e man under ether,and

,if he did not succeed in returning the hern ia

by taxis,to operate . Ether was accord ingly admin

istered , and as the hernia would not yield to moderate taxis, a small incision of about on e and a halfinches in length was made over the tumor upon theexternal abdominal ring

,which was apparently the

seat ofconstrict ion . This was divided, and thebowel was returned with in th e abdomen withou topen ing the

_sac. The wound was closed with twosutures

,and dressed as in the other two cases.

The patien t received immediate rel ief from theoperation . The pain and vomiting ceased. Onthe fifth day after the operation the bowels actedvoluntarily. On December z o th th e wound washealed. On December 2 6th the patien t left thehospital qu ite well, and wearing a truss — Tag Lancet.

THER APEUTIC USE OF IODOFOR M .

Locally,iodoform

,as a dry powder, brushed

ligh tly over the surface with a mo istened camelhair pencil

,has been for three years my almost

invar iable treatment ofvenereal sores , espec ial lythe local chancre. During the last few mon ths, Ihave often substituted for the dry powder an

ethereal solut ion (one part ofiodoform in six or

eight of ether) . The sore is touched or dabbedw ith a pencil d ipped in the ethereal solution

,ac

cording to i ts s iz e and depth,l ightly or copiously.

The ether quickly evaporates,leaving a thin pell icle

ofiodoform ,that as effectually stays the spread

and produces heal ing ofchancres as does the morecop iously appl ied dry powder. Thus th e surfaceis covered more exactly

,and the disagreeable

smel l ofthe iodoform is too fain t to attract attent ion. The sore is well washed with water anddried before the idoform is applied, and the surfaceis lastly protected by a bit ofdry l int. When thesecret ion is abundant, the dressing must be renewedtwice daily

,but in three or four days the amount

ofdischarge becomes so scant that one dress ingper a

’

iem suffi ces.In th is way

,venereal sores heal quickly. Pain

subsides at once 5 the sore i s well in a week orten days , and the chances ofconsecutive '

inoculation or bubo are greatly lessened. In a veryfewcases

,th e appl ication of iodoform gives momen

tary smarting, which is very bearable ; even theethereal solu tion does not hurt

,and usual ly the

patient declares the appl ication to be qui te painless. I avoid u sing iodoform on inflamed sores,or on simpl e granulating wounds

,but indolen t

non specific ulcers are rapidly improved by iodoform local ly applied .

Lately,I have given iodoform internally with

great benefi t. I t acts more rapidly than potassicor other iod ides

,and

,j udging from experience

thus far,is as readily borne as are those sal ts. I

have given i t in one-and-a—half-grain doses as a pillwith extract ofgentian . Three pill s are given eachday

,increasing gradually til l eight or ten pil ls are

taken in twenty-four hours.

I have used it with excellent effect in cases ofobstinate syphil itic ulcerat ion of the tongue, wherethe dorsum is covered with rugged th ickenedep ithel ium

,which is constantly spl i tting into deep

fissures,and thus causing cont inual severe pain to

the patient. This affection is often qu ite insens ibleto mercury

,alkal ine iod ides

,or arsenic the reme

dies usually beneficial . . In three ofthese obstinatecases

,where I had been treat ing the patients at

intervals for years with the remedies j us t mentionedwith l ittle lasting benefit

,iodoform p ills have acted

l ike a charm . Pain,immed iately lessened , in two

or three days ceased wholly and the fissureshealed rapidly

,while the tongue soon shrank to

i ts natural s iz e . How long the rel ief wil l endure ,t ime alone will show but any interval ofonlyapparent cure ofthis very painful affection is agreat blessing to the sufiferer

,and time is given for

the exhibit ion of mercury if required. In December last

,I had under my care in University Coll ege

Hospital a patient w i th ulcerated and protrudinggumma of the left testis

,non ulcerating gumma of

the right testis,and ulcerating gummata of the skin

THE“

CANADA LANCET.

place,notwithstanding that

,when th e dose of

pill s p er diam had been reached and admind for three days

,an outbreak ofpyrexia

,

a, and iodic acne rendered i t necessary toth e drug completelyfor a short time. In

times d aily, was at once rel ieved of pain by theiodoform pill taken three t imes daily

,though on

the third day, nausea became too urgen t to allowt he iodoform to be continued in that quanti ty ; i twas at first diminished til l pain ceased

,and then

discontinued altogether. Th is small experiencen iodoform we have a verystore ofweapons for fightingservation will enable u s to

and when most su itable .B r z

’

t. M erl. 7 onrnal.

CHLOR AL-HYDR ATE IN DELIR IUM

TR EMENS.

A short t ime ago,I was almost despairing of a

case of delirium tremens . The man was mostviolen t, and in a fearful s tate ofexcitement ; andthe remedies adopted appeared only to increaseh is activity and make h im more and more unmanageabl e. The treatmen t had been Battley

’

s solution in half-drachm doses afterwards pure solutionof the hydrochlorate ofmorph ia by subcu taneousinj ection

,as much as one grain repeated every two

hou rs . There was n o vomiting of the m ixturesgiven on any occasion ; these being, in addi tionto the l iquor op i i sedativus j ust mentioned, halfdrachm doses oftincture '

ofdigital is given every

SLEEPLESSNESS AND ITS TR EATMENT.

hundred grains,and ofmorphia on e grain and one

sixth , in the space ofan hour and fifteen minutes .Previously to the admin istration ofchloral , th epupils were contracted to a po int : an indication ,ofcourse

,that the previous m ixtures had been

absorbed,bu t

,as we have seen

,with th e effect

only ofincreasing the excitement . Consideringthat the preparations ofopium given previouslyhad not conduced to somnol ency, I attribute th iscondition to th e chlo ral-hydrate chiefly, i f notentirely. In another obstinate case ofdeliriumtremens

,in wh ich the usual treatment by digi tal is,

morphia,etc.

,was ineffectual

,I had recourse to

chloral , repeated every ten minutes t il l one hundredand sixty grains had been taken . The patien tthen fell over

,and

,after sl eeping for seven hours ,

was,on awaking

,al together a changed man .

I may add that,during the first two doses, there

is always increased excitement,the pat ient becom

ing garrulous— indeed, i nfox icated , to al l appearance ; but th is soon gives place to th ick speech ,inarticulate mumbl ings , and peaceful sl eep — D r .

74Far rar i n B r if. M ea’

. y oarnal,Jan . 26

,

’

7 8.

Dr. Ainsl ie Hollis, in writing on this subj ect,maintains that

,al though th e quanti ty ofblood in

the brain is diminished during sleep , this diminat ion is not th e sole cause ofslumber,for we mayhave th e former without the latter. An increas ein the cerebral blood-supply

,however, may produce

wakefulness,as in the paresis ofthe cerebral vaso

motor nerves from exhaustion . Sense impressionshave the same effect by the continual stimulationofthe higher n ervous centres . An increase in thevelocity ofth e blood-cu rrent through the brain isa frequen t cause ofwakefulness, as in the i rritableand hypertrophied heart. The wakefulness ofanaemia is ascribed by W i llem in to changes in the

nervous elements ofth e brain,and a consequen t

modification ofthe circulation therein .

The treatment for wakefulness h e classifiedunder two heads

1 . The induction of natural sleep .

2 . The production of narcosis, or art ificial rest .One ofth e most effi cien t means ofinducingnatural s leep is the appl ication ofmustard plastersto th e abdomen . According t o Schuler, this produces first dilatation

,and subsequently contraction

of the vessel s ofth e pia mater ; changes due to th econstriction or dilatation ofthe peripheral currentareas ofthe skin . Preyer, ofJ ena , advocates theadministration ofa freshly made solu tion of lactateof soda , or ofsome m ilk, or whey, on th e hypothes is that sl eep may be induced by the introductionofth e fatigue products ofth e body. Where theinsomnia depends upon brain exhaustion , Dr. Holl is recommends the administration , j us t before

THE CANADA LANCET.

bed-time,of a tumblerful of hot claret and water

,

with sugar and nutmeg. The alkal ies and alkalineearths are useful when acid dyspepsia is associatedwith insomn ia. Electric i ty has been used in theparesis ofthe vaso-motor nerves due to an overworked brain. In hot weather, sprinkl ing thefloor of the sleeping apartment with water lessensthe irritant properties ofthe air, add ing much tothe comfort ofthe sleepers ; possibly the quantityofoz one i s at the same t ime increased .

The artificial rest obtained by the use ofnarcotics seems to be due to a direct interference withthe functional act iv i ty ofthe nervous system . Dr.Hollis does not consider the brom ides to possesshypnotic properties

,although they undoubtedly

act as sedat ives on the nervous system ,and as

such may occasionally induce sleep — Ti leFractitioner .

PAR ACENTESIS OF THE PER ICAR DIUM,

WITH AN ANALYSIS OF FOR TYONE CASES.

Dr. John B . R oberts,

1ofPhiladelphia, gives an

interest ing resume of th is operation from the earl ies tt imes

,with the ind ications for treatment and the

general resul ts that may be expected. R iolan firstproposed it in 1 649 , and R omero performed thefirst successful operat ion at some t ime b efore 1 8 1 9 .

Paracentes is l S indicated when the effusion is large land threatens to destroy l ife

,ordinary treatmentfail ing to produce absorpt ion . The period that

the surgeon must allow to elapse before tapping, isas yet undecided. As a method ofgiving rel ief inchronic cases i t is probably no more open toobj ections than is excision ofthe breast or tonguefor cancer. The particular method of operating isnow tolerably un iform . A small aspirat ing needleis to be used

,— so small that i t s imply makes a

fine puncture that would not harm the lung if thatwere p ierced. The point recommended by Dieulafoy 1s in the fifth interspace

,about three quarters

of an inch from the edge ofthe sternum . Infifteen out ofth irty-four cases this point was chosen .

”

The dangers to be dreaded are wound ing oftheinternal mammary artery

,and striking the heart as

it is thrown forward in systole . By adopting D ieulafoy’s plan the artery is avoided , as i t l ies from aquarter to half an inch from the edge of the s ternum . Inj ury to the heart may be avoided byhav ing a canula sl ide over or with in the needle,thus guard ing it s sharp poin t. The heart mayprobably

,however

,bear a certain degree of inj ury

with immunity,according to Eve

,Steiner, and

(others . Baiz eau and R oger tapped the ventriclewithout doing harm

,both patients surv iving the

1 New York Med ical Journal, December, 1876. NewYork Med ical R ecord , January 20, 187 7 .

THE ADMISSION OF WOMEN TO MEDI

CAL DEGR EES.

Dr. Tilbury Fox in a recent number of l e Lan

cet says, I hope you wil l allow me to direct attention to the kind ofexamination— as shown byrecent papers— which women will have to un

dergo, i n company with young men , in order togain admission to the medical degrees of theUn i vers ity ofLondon . I ask this i n the hopethat many of the Arts

,Laws

,and Science gradu

ates who read T/ze Lancet may be enlightenedupon th is particular point.On turning to the examination papers for the

last half—doz en years , I find,amongst others, the

following questions,set by the exam i ners

F irs t M.B .,July 3oth , 1 87 7 . Describe the

membraneous porti on ofthe male urethra, and thestructure in immediate relation therewith. Menti onthe chief points ofdifference ln th e female subj ect .”M .S .

,1 8 7 2 . Describe fully the character of

so called soft and hard chancre, St e.

”

Second M .B . 1 87 3 . Give an account ofthemodes in which syphil is becomes propagated ; thedetail s by which the poison is d iffused throughoutthe system , &c.

”

Firs t M .B .,1 87 3 . Describe the connexion of

the lower four inches of the rectum in the male,the naked -eye character ofthe coats ofthe gut forthe same d is tance,F irst M .E.

,1 8 7 5 .

— Give an account of the geni to-urinary organs of the human male.”

operation,though in one case one hundred and

fi fty and in the other two hundred and fiftygrammes of blood were drawn . As for the dangerof th e operation in these forty-one cases , regardingone in wh ich the final resul t was not given as afatal case

,the mortal ity was per cent. But

then the effus ion in many ofthem was merely as ingle factor ofdisease in fact

,in seventeen there

were other concomitant and often incurable affections. In five fatal cases no other disease wasmentioned

,which puts the mortali ty at per

cent.,supposing i t to have been from cardiac

dropsy alone . Since the year 1 850, ofthe un compl icated fatal cases the mortality has beenper cent.

,which , though not so low as the figures

given for all the uncomplicated cases taken together

,is perhaps as low as in many other operative

procedures that are regarded as perfectly j ustifiable.In acute rheumatic pericardial effusions the resultshave been excellent where

,however

,the d isease

becomes chron ic a perfect cure is almost hopeless,for

,owing to the long ‘ continuance ofth e inflam

mation,the maceration of the heart

,and the pres

sure ofthe distended sac, the tissues have assumednew pathological characters — B oslonMea

’.y earned .

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214

followed with safety,and opened up a n ew field of

observation that promises results“

as grand as thosenow ach ieved by ovariotomy. He has raised sorrowing women from a perfect slough ofdespond

,

from indescribable suffering, from epileptic con

vuls ion s,from repeated pelv ic i nflammations , haema

toceles and abscesses , from vicarious and alarminghemorrhages

,from threatened insan i ty

,and

,i n

some ins tances,from impending and certain death

,

and restored them to heal th , to friends, to usefulness

,and therefore to happ iness .We have precedents enough for naming diseases

and operations for those who have been the firs t todiscover and describe the one

, or to originate andperform the other. I may name Bright’s disease

,

Addison ’s disease, Colles’ fracture

,th e Hunterian

operation,Syme’s operation

,P irogoff’s operation

,

Graefe ’s operation , etc. The moment they arenamed

,we recogniz e each Operation

,and the man

ner of executing it in its man ifes t details. Le t ushonor Battey by call ing th is Battey

’s Operation .

’

THE PANC REAS 1N D IABETES .—M. Lancereau

laid before the Académie de Medicine somespecimens exh ibiting extensive lesions ofthe pancreas in subj ects of diabetes

,and having related

the histories ofthe cases whence they were derived,

and referring to others already on record, went onto say that i t was thus evident that

,at l east in some

cases,diabetes is accompanied by great al terations

in th is organ . In these cases the progress of thedisease has been relatively rapid

,and has been at

tended by polyphagia, polydipsia, excessive emaciation

,and abundant glycosuria— in fact

,by all the

characteris tics ofsaccharine diabetes. So,also,

animals from which the pancreas has been removed,

became voracious and rapidly emaciated,and d ie

very quickly. There would seem,therefore

,to be

no doubt that there is a casual relation betweenthese changes in the pancreas and the disease inquestion . This form ofd iabetes may be distingui shed by the relatively rapid occurrence of emaciat ion with polyphagy and polyd ip sia and by thepecul iar character ofthe alv ine evacuations . Itsprognos is is most unfavorable ; the indication fortreatment consists in suppressing alimentary substances that are digested by the pancreatic juice,in favor of those which undergo digest ion in thestomach — G ag .

A LADY PR AC I‘ ITIONER IN D I SGUI S E .— A Dr.

James Barry served as surgeon in the British Armyfor more than fifty years

,during wh ich t ime he held

many important medical offi ces, and gained an en

viable reputation as a cool and skilful operator.He was ofa very irri table temper

,and

,while sta

t ion ed at the Cape ofGood Hope, fought a duel .Notwith s tanding frequent breaches ofd iscip lin e,he

. a’es H op

— Al ana ! Times and

THE CANADA LANCET.

The French have passed a law that Every person who may be condemned by the pol ice forcetwice for the crime ofOpen drunkenness will beheld incapable ofvoting, ofelective el igib il i ty, andof being named for the j ury or any public offi ce.”A F I BRO C YSTIC tumor of the u terus cured by

ergot is reported 1n the Boston Medical and Surgical Journal . The ergot was given in half drachmdoses thrice daily.

attained high rank in the army,served in many

parts ofthe world , and in 1 865 , h is name stood atthe head of the l i st ofinspectors-general ofhospitals . In July 1 865 , th e eccentric surgeon died,and the next day i t was officially reported that thedoctor was a woman . No suspicion ofth e surgeon ’s sex seems to have been entertained

,even

by his most in timate associates. In add it ion toh is other accomplishments

,Dr. Barry was an in

veterate smoker. — 1Ve'zo York y onrnal.

AC ETIC AC ID IN PsoR IAS Is .— Dr. Jansen (R enae

Médicale) finds acetic acid the most effectual app l ication . After a bath ofhot water and soap tosoften the crusts, the scales are to be removed bya smal l brush . The acid is then appl ied by meansofa sponge. Very soon the affected parts becomepale, then inj ected , and finally sl ightly inflamed.

There is a feeling ofsmarting,which lasts half an

hour. The crusts fall off,and in some cases ap

pear no more after the fifth or sixth appl ication ;in Others they reproduce themselves for a longertim e, gradually becoming less and less thick. Onlyone application in the twenty-four hours should bemade, and the parts should be carefully bandaged.

OVAR IOTOMY.— Prof. Donald Maclean ofAnnArbor has wi thin the pastfew months performedthe Operation of ovariotomy six times. Several ofthese cases were very compl icated , requiring theremoval ofboth ovaries, etc. The result has been

,

five cases of complete recovery,and one death. In

the latter case the tumor was ofover twenty years’growth and weighed upwards ofone hundredpounds. These cases show a mortal ity ofbut 1 6§per cent. , which is the best resul t yet obtained inthe Northwest. The doctor promises a detailedreport of h is casesfor an early number of the News.FRAUDULENT LENSEs .

—T/ze New YorkM edical

R ecord reports that quite an excitemen t has beencreated in that city by the discovery that one ofth e leading opticians is in the habi t ofimportingfrom Paris ordinary commercial lenses

,remounting

them after the English style, and palming offsuchinferior productions as the lenses of the bes t makers.The fraudulent practice has probably been carriedout by American opticians for a long time — C lin ic.

THE CANADA LANCET.

TOR ONTO ,MAR . I

,1 8 7 8 .

du ty to announce

[

ofToronto, afterDr. Hodder was

the son of Captain Hodder, R . N. , and was bornr

at Sandgate , Kent, England , in 1 8 1 0 . He was

educated, when a boy, at Guernsey grammar school ,and afterwards at St. S ervan s , France . In 1 8 2 2 he

entered the navy as a midsh ipman under his father,

but left the service at the expirat ion of on e year,

and having great taste for medicine, he soon after

commenced its study under the celebrated Mr.

with whom he was articled for five

pas sed the exam ination‘ofthe. R oyal

Surgeons,England , in 1 834, and re

ceived the diploma ofmembersh ip , after which he

surgeon , until the time of h is

r was married to a daughter of

M . 8 7 th R oyal Irish Fusiliers .he leaves a large family ofsonsoum h is loss.

degree ofC. M . from King’s

.D., from Trin i ty

elected a Fellow

of the R oyal College of Surgeons,England

,and in

1 865 a Fellow ofthe Obstetrical Society of Lon.

don , and was one of the honorary local secre tariesofthe latter society.He was Prof. of Obstetrics in the Medical De

partm en t of Trini ty from 1 850

until its discontinuance in 1 85 7 . Subsequently h e

lectured on the same branch in the Toronto Schoolof Medicine for several years. 011 th e revival of

the Trinity College Medical Department in 1 870 ,

he was unanimously appointed Dean ofthe Facul tyand in 1 8 7 7 he was reappointed Dean ofthe newlyincorporated Trinity Medical School . He held a

posit ion on th e acting staff of th e Toronto GeneralHospital for a period of 20 years

,and was ap

pointed ou the consult ing staffin 1 8 7 2 . He was

also consulting surgeon to the Burnside Lying-inHospital , Children

’s Hospital, &c.

, &c.

He was a most enthusias tic yachtsman,and for

many years past held th e position of Commodore

of the R oyal Canadian Yach t Club.

Dr. Hodder was a prominent member of‘ th eCanada Medical Association and was elected Pres

ident at the meeting in Hal ifax in 1 8 7 5 . He was

also a member ofthe Medical Council ofOntari ofrom 1 8 7 2 up to the t ime ofh is dea th . As a sugeon h e was bold yet cautious

,and was very suc

cessful in al l h is operat ions . As an ovariotomis t

he was admittedly the mos t successful in Can

ada. He was the author of several papers on medical and surgical subj ects, publ ished from time totime in the medical J ournals. He was the firs t to

inj ect mi lk into the veins in collapse. This he did

in the s tage ofcollapse in cholera during the ep idemic Of1 842.

Dr. Hodder had notbeen in good heal thfor severalmonths past. He complained ofmore or less constant headache over the left temple

,with weakness

of voice , thickness ofspeech , and general debility.

On the 1 5 th ofJanuary he was suddenly seiz edwhile sitting at h is dinner-table

,with complete par

alysis ofspeech and deglutit ion. There was also

inabil ity to protrude the tongue,and rigidity ofth e

righ t arm . These symptoms partial ly disappeared

in a day or two, and he was abl e to sp eak indis

tinctly in monosyllables, but almos t invariably said

yes for no and the reverse. At the end often or twelve days he so far recovered as to be

able to move about with a l i ttle assis tance.His

mind was tolerably clear at times,at other times

216 THE CANADA LANCET.

very hazy. Though there never was any paralysis mati es ofmedical science, and the success Wi tltofth e extremities, yet he never attempted to help which i t has been employed oflate by manyhimself

,and appeared to have great difficulty in

finding words to express his wishes .

well marked . His progress towards recovery was

never satisfactory. About a week before his death

his strength began to fail and he was obliged to

remain in bed. Symptoms of serous effus ion setin

,and h e became t omatose about forty-eight

hours before his death . The diagnosis was wh i tesoftening ofth e left anterior lobe -ofth e brain.There was no pos t mor tem .

His death is a loss of110 ordinary value,and

will leave a blank very difficul t to fi ll,for medical

men ofhis ripe experience and acknowledged skillare very few in number in this or any country. He

was much beloved by those ofhis patients andfriends who knew him best. Although sometimesbrusque and abrupt in manner, he was yet k ind atheart

,and his loss wil l be sadly fel t by many pa

tien ts and friends al l over the country. In his

death the profession also loses on e ofi ts brigh testornaments ; on e whose gifts were ofno ord inarycharacter

,and whose talents were almost entirely

consecrated to the faithful discharge ofprofessionalduty and the wel l-being and advancement ofthehighest interests of h is profession .

His funeral was largely attended by the students

and members ofthe Faculty ofboth medicalschools

,the medical profession and the general

public.

SANITAR Y BOAR DS.

I t i s a matter for congratulation that the Legi s

lature has appointed a commission to enqu ire into

the best mode ofprocedure for guarding againstthe numerous factors ofdisease now existing inour cities, towns, villages, and country gen ei ally,and that to assist in th is important task, they haveavailed themselves ofth e experience ofa numberofcompetent medical men . We would fain hope

that the commission will not cOnfine itself to the

eminen t observers, particularly Mr. Simon ,affords

Aphasia was assurances of the resul ts that may hereafter beexpected from this sou rce. We must compare

together, says M . Louis , (Memo ires de la Societ

Medicale d ’

Observation d e Paris) a great numberof cases ofthe same d isease of equal severity

,

some relating to subj ects in whom the disease wasleft to i tsel f, others of individuals to whom certain

medicines were given . After doing this,we must

study the action ofth e same therapeutical agenton those in whom th e disease was severe

,and on

those in whom it was sl igh t; or those on whom the

remedy has been used in large or small doses at a.

period near to , or remote from the commencemen t

ofthe disease . This last circumstance is very '

important. S o, l ikewise, we must men tion whether

the medicine is used alone, or in conj unction with

other remedies. But not only does this methodrequire much labor, but i t also su pposes a consider

able series of facts, the conn ection of wh ich i sdiffi cult, especially when treating severe affectionsin wh ich we are accustomed to make new attempts»,

and which will not allow ofour remaining a merespectator ofthe progress of the disease. For i tmus

’

t be eviden t that we do not seek to know byapproximatiori what remedies have appear ed to bemore or less successful, but to demonstrate in arigorous manner, that a certain I emedy. or certainmethod is u seful or hurtful

,and in different degrees

,

according to the manner in which we employ it.

”

A glance at the history of medicine shows,that i t

has suffered more from faul ty observation and

false facts, than from false theories ;for after allmost ofthe theories have been based upon fanciedobservation . Averages and numerical methods

can in no case, however, afford more than anapproximation to the truth

,yet the approximation

is closer than can be attained in any other method.

Accuracy in diagnosis is the first essential.I f

,as

there is too good reason to'

suppose,in epidemics

ofdiphtheria, ordinary cases of inflammation ortask ofd evising th e best scheme for the govern u lceration , are included In the estimate of number

,

ment,in the future

, ofBoards of Health , but to that what value attaches to the percentage ofdeathslabor add another very importan t 0116

,VIZ

, an and recoveries, or to th e therapeutic agent emimprovement in the means at present employed ployed ? Without that accuracy

,what reliance I s

for collecting m edical statist ics. Averages , as S ir to be placed in the vaunted cures of all the ill sH

.Holland observes in h is “ Notes and R eflec that flesh is heir to

,

” by the most recent craz e

tions,

” may, in som sort, be termed“ the mathe electric baths P History repeats i tself some sixty

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218 THE CANADA LANCET.

They have l ived in malarious districts, sl ep t on the

banks of malarious rivers for years, without con

tracting any ofth e forms offever pecul iar to suchneighbourhoods, and ascribe their exemption solely

to the habit ofbreathing through the nose .l n ci ties and other centres of contagion many

examples ofthe unnatural “ mouth ” resp iration

may be seen,which is always hurtful . No perfect

rest in sl eep,can be obtained with the mouth open

,

and quiet rest is a valuabl e consideration i t i s

nature’s great restorer. Mr. Catl in i n h is l ittl e

work entitled Shut your mouth and save your

l ife,” contrasts the natural repose ofan Indian

ch ild,with th e uncomfortable slumbers )f. an infan t

of civiliz ation,with its wide open mouth and

gasp ings for breath . The Indian child,was never

allowed to sleep with i ts mouth open as it fel l

asleep the savage mother never failed to press its

l ip s together,t ill sh e had fixed a hab it that was to

las t for l ife for when these ch ildren grow up,waking or sl eeping they keep their mouths shu t .”

And to this habit,he ascribes the immunity that the

native race of America then enj oyed from the de

plorable diseases and mortali ty rate among civil iz ed pho id fever, et i zacgenus 0mm .

p eople . Among two mill ions of these people that

he had visited,he n ever saw or heard of a hunch

back or crooked spine,an idiot or a lunatic

,whilst

premature death was quite uncommon . The

mouth should be kept closed when in a crowded

or dusty room,when among a crowd at any time

,

when on th e street,in the field

,work shop or m il l

— in fact at al l times when possible so to do.

If the habit i s once acqu ired and put into practice,

i t wil l pay In Improved heal th and prevention ofdisease . A firmly closed mouth also promotespersonal beauty ; Open mouths cause the best

features to wear an insipid and unattractive ap

pearance.

LEGISLATIVE SANITAR Y COMMITTEE.

The committee recently appointed by theOntario l egislature to enquire into and reportupon the san itary condition ofth e Province havei ssued a number ofquestions addressed to medical men wi th the view ofcollecting as much informaiton on the subj ect as poss ible. As was to be exp ected some physicians who have paid attention to

such matters have sent repl ies,but t h e great major

disposed to laugh at the absurdity ofquestions . Many ofthe questions wportant and should have been repl

have before us the repl ies given byBrantford

,to one ofthe question s with its 5

division s A,B,c, from which we take afew

cerp ts.

A.— Drainage —nature

,extent, etc. There

practically,no drainage in the city ofBrantford,

cept private drains . In most cases,house drain

passes in to large cess-pits at a distance from

houses ofthese areold ones.proximity

five feet

the older

B -Nature ofsoil and distance to bed rock.

The soi l on the surface is mainly sand and graVel.The city is buil t in a basin of the grand river valley

the s ides ofwhich rise to about 1 00 feet all around,enclosing an area ofabout 1% miles in breadth

and 3 in length , the h igh lands draining natural ly

down to ther iver. The natural drainage is thus good,and the facil ity for artificial drainage, th e best thatcould be secured. The sand and gravel vary in

depth,from a sl igh t covering in the low grounds to

from 50 to 60 feet in the high below i t, l ies clay,yellow and blue which has a thickness offrom 50 to1 50 feet, and in some places probably more , before

the Onondaga l ime-stone is reached .

C .— Depth ofwells, qual i ty of water, supply,

ample or l imited. Wells,dug from 20 to 30 feet

deep,are ge nerally abundantly suppl ied with water

from the clay beds. That the wells and springsare supplied

,in part

,from the surface water, due to

the prec ipitation ofrain and snow,i s very man ifest.

The increase of late in the number of wells is lower

ing the water l evel and diminish ing the flow of

THE CANADA LAN( JET.

ble and soluble elements of the soili t

,

passes,and cannot fai l to be

numerous cess-pools that l ie in i ts

the wells,there i s an artificial supply

certain springs,forced by steam

streets

e as m uch exposed to d iseas e

as are th e crowded parts ofThere is besides

,such almost uni

rance ofgeneral uncleanness,

-and into its dangers , that l ittle or no hope

tertain ed ofvoluntary local improvement.a changefor the better

,aid and compul

must come from the Legislature.

MEDICAL CONTR ACT SYSTEM.

In another column wil l be found a letter

Mr. Broughton , manager ofthe Greatern R ailway Company Ham 11t0n , In re

to the tariff ofmedical fees adopted by theing to that Company. In

the letter, we do not wish to be underin any way endors ing his views. Fromrience ofthe medical contract system

,both

and elsewhere, either in connection withhy corporations or charitable societies

, we

no h esitation in saying that i t i s most perniin i ts tendency, and highly inj urious to the

interests ofthe medical profession . This

is rapidly looming up,and will sooner or

the profession for settl emen t.

be made them by secret orders orome

“ club doctors ”for the sakeit gives them

,and th e opportunity

ofa possibl e extension of theirlong wil l “ societies ” take advan

NEW THERAPEUTI CAL NOTEs .—Ih the new form

of in-st itch,introduced th is month by the firm of

McKesson R obbin s , will be noticed some ther

apeutical notes on n ew remedies prepared by them

in the form of gelatine coated pills, and granules.

These preparations are most elegant in appearance ,easy of adminis tration and well worthy ofthe careful consideration ofth e professwn .

quite agree with the statemen t ofour correspondent, that we can see no difference between accepting one dollar '

per head from the provident societyofa rai lway company

,and accepting a similar

appointment from a lodge ofOdd-fellows ,”O rangemen

, or“ Foresters. The princ ipl e is

th e same in b oth cases,and ut terly at variance

with sound business principl es,as well as deroga

tory to th e dign ity ofth e profession . We have

nothing to say again st charitable societies ; they are

very useful in their way when properly conducted ,but they have no claims upon the medical profess ion for what i s next th ing to gratuitou s services,any more than they have upon the legal or any

other profession . Who ever h eard oflawyers giving their legal services to a body ofmen associatedtogether

,or a society or lodge,for so much per

head per ann um P On the other hand, we bel ievethe members ofth e society are not as well caredfor

,as if th ey were attended in the ordinary way.

There i s a d isposmon to reduce to a minimum the »

servi ces rendered, under the circumstances ofsuchlow fees . I t is also a well-known fact, that the so

cieties are not able to secure th e services oftheablest and most experienced physicians, for as a

rule,these are too busily engaged in their private

practice to undertake work ofsuch an unremunerat ive and unsatisfactory character— nor will any

physician,no matter how skilful he is, be accepta

bl e to every member ofthe society. The resul t‘

is,that many ofthe members, al though they pay

th eir qu ota towards the physician , never send for

h im in case ofsickn ess i or acciden t. There can be no t

obj eet ion to m embers ofsocieties or lodges assisting each other in case of sickness or _ accident, by

contributing a certain sum to pay for medical at

tendance,but each member should be left free to

call in th e physician ofhis choice, who should bepaid h i s ordinary fees out ofth e funds so contributed. This plan

,which has been adopted by

several charitabl e societies in th is city and else

where,i s the only rational one.

220

MEDICAL LEGISLATION.

The Executive Committee ofthe Ontario Medical Council has framed and introduced a B il l in tothe local Legislature to amend and explain themeaning of the Ontario Medical Act. It has been

taken in charge by Dr. Clarke,

for Norfolk.

With the provisions of the Bill as i t stands,and the

clauses that are l ikely to pass,there can be no ob

jection ,but i t does not go far enough . There

should be increased territorial representation,and

the medical men in the House will fail in their

duty if they do not introduce an amendment to

that effect. The period ofmembersh ip should alsobe reduced from five to tlzree years . The Medical

Council should also have power given to it,similar

to that which obtains in the Law Society,of regu

lating the internal d iscip line of the college and of

striking from the 1011 any who are guilty offlagrantviolation ofi ts rules and regulations. The matterofadmitting to registration

,without further exam i

nation, C anad ian graduates with additional Britishqualifications, after an extra course ofmed icalstudy, should be also providedfor. We also trustthat a clause will be introduced regarding the appointment ofthe exam ining board. I t is a mon

strous thing that the members ofthe Councilshould have power to constitute themselves the

examiners , and also pay themselves $ 1 00 each,forthe performance ofthat du ty. This has done moreto bring th e council into d isrepute than almost any

other act. But for th is circumstance,we never

would have had those d isgraceful proceedings oftwo years ago at the Toronto University. We trust

that the members in the House wil l not allow the

opportunity to sl ip,of making certain amendments

which are much more necessary than those now

introduced.

OVAR IOTOMY.— Our subscribers will doubtless

be pleased to learn that the paper on Ovariotomy,

prepared -for the late meeting ofthe Canada

THE CANADA LANCET.

such

recou

Drs.

very gravepunished already fully equal to the sum oftheiroffence . Let there be a complete acknowledgment

oftheir error, and an ample apology in writing tothe President ofth e College and any others whohave been affected

,and let the matter be dropped

for ever.MEETING OFTHE ONTAR IO MED ICAL COUNC IL.—It would be very desirable if the meeting oftheOntario Medical Council could be cal leJune th

'

council and others who take an interest in the pro

ceed ing

during the summer months,when practice is

ally quiet. An early meeting would therefore

great accommodation to such persons, and i n no

way inj urious to the interests of the council.

TELEPHON IC AUS C ULTATION.— The1atest nov

in medical practice is tel ephonic auscultation.

Med ical Association by Dr. J . W. R osebrugh , of a British exchange the writer S 3W :“ he l is te

Hamilton , will be commenced in the April numberofth e LANC ET. As Dr. R osebrugh is understoodto have had considerable experience and very goods uccess as an ovariotomist

, his paper, we are sure,will be looked for by our readers with muchi nterest .

to a young lady’s C hest with a telephone ;

trary to the expectation ofmanyin Montreal and elsewhere

,have

for trial in a higher court,by the

made the prel iminary investiga

obliged to give bail. I t will be

gretted , ifthe courts .

ALC OHOL IN THE TREATMENT OFHYDROC ELE .

A favourite plan for the treatment ofhydroceleby many em inen t surgeons of the day, i s to inj ect— by means ofa hypodermic syringe— from a few

drops to on e fluid drachm ofalcohol (Spts . Vin.

R ect.) into the sac. The heat of the scrotum is

increased,temporarily

,but the process ofcoagu

lation of the albumen ofth e fluid at once takes

place,and a complete cure speedily follows.

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222 THE CANADA LANCET.

R ES IGNATION — Drs . Dewolf and Fraser oftheHospital for Insane

,Hal ifax

,N. S .

,have resigned

the offices of medical superin tendent and assis tantm edical superintendent respect ively. Troubles of

a rel igio-pol itical nature are the reasons assigned. ser and Edwards.

I t was moved and seconded that Drs . Bucke,

Fraser and McLean constitute the Printing Comm itteefor the year ensu ing

,and that th ey be em

powered to exercise their option with respect to

the publ ication ofpapers in the forthcoming transThe death ofClaude Bernard

,the discoverer actions ;

ain ong other th ings ofth e glycogenic function ofOn moti on “5 was dec i ded to hOld the meet ingsthe l iver is announced. He was 65 years ofsemi-annually in future, at Detroi t in June and

London in January.

The death ofDr. E. R . Peaslee ofNew,York The following offi cers were elected for th e en

was announced on th e z r st ofJanuary.

suing year—Dr. Tye

,President Dr. McAlp ine,

V i ce-Pres i den t for M i ddlesex Dr. Lougheed,

APPO INTMENTS — Dr. A. P. R eid has been ap Vice -Presidentfor Lambton ; Dr. Lambert, Vi cepo i n ted medical superintendent, and Dr. Geo. L. President for Essex ; Dr. Samson, Vice—PresidentS inclair assistant medical superintendent of the for Kent ; Dr. Fraser, Treasurer ; Dr. Beemer,Hospital for the Insane, Hal ifax, N. 5 They are Secretary ; Drs. Bucke and R ichardson , Auditors.both members Ofthe Faculty ofthe Hal ifax Medi Dr, Fl eming read a, careful ly prepared paper oncal College . the Causation and Pathology ofTyphoid Fever.”R . Mattice, M-D Of Moulinette, to be an A long and sp iri ted discussion followed upon

Associate Coroner for the united Cos. of Stormont, this subj ect, which was very ably deal t wi th by a

G. T. McKeough , M B . Trinity Medical School

has passed the primary examination ofthe R oyalC ollege ofSurgeons England. Also D . H . Dows

l ey, M.D . , Kingston, Ontario.

Dundas and Glengarry . number ofgentlemen present, among others byN Brewster

,M °D'

:Of R idgeway, to be an AS S O ‘ Prof. McG raw, ofDetroit. The conclusions ar

c iate Coroner, for the C O Of Welland. rived at were that typhoid fever may be,though

H . N . Ell iott, ESQ ; Of Manitowaning, to be an rarely is, communicated from the patient to aAssociate Coroner

,for the District Of Algoma. healthy person , or may result from imbibition of

J A M 'D°»Of Hast i ngs, to be an ass oc i ate Impure water or by Inhalati on ofpo i sonous atmoscoroner for the Counties Of Northumberland , phere. A vote ofthanks was tendered Dr. FlemDurham and Peterborough . ing for the paper.l R Anderson , MD ” Of All” Craig, to be an Dr. Bucke, Superintendent oftheLondon Asy

associate coronerfor th e County ofMiddlesex. lum for Insane then read an elaborate and wholly ‘

P. L. Graham , M .D .,ofBothwell , to be an original essay on

‘i

‘The Moral Nature and the GreatAssociate Coroner for the County ofKent. Sympathetic for which he received the thanks of

the association . Prof. McG raw was elected ani ttpurtfi “i fiflt lt ll tfi. honorary member of the association. Papers were

promised for the next meeting by Drs. McG raw,WESTERN AND ST. C LAIR MED IC AL AS SOC IATION. Holmes, Lumley, and R utherford . The meeting

The annual meeting ofthis Association was held then adj ourned,after wh ich the members enj oyed

at Chatham in January las t. The members present the hosp ital ity ofthe Chatham Medical Associa-nwere as follows z— Drs. Bucke , Fraser, Beemer, t ion at the Garner h ouse.M itchell, Samson , Van Velsor, Tye, Smith , Graham

,R utherford, Lumley, Bray, Holmes , Murphy, FAM INE

,ofa terribl e character, prevails in several

R ichardson , Brigh t, Fleming, Van Allan , Sive ofthe northern provinces ofChina ; immense dis 2wright

,Abbott, Winter, Professor McG raw

, ofDe tri cts are almost depopulated. The same state oftroi t, and Dr Tates, Of Wash ington . afiairs obtains in several large districts of BritishThe minutes of the last meeting

,held at Sarnia

, India.

THE CANADA LANCET.

and the same mechan

the paroxysms,comes

ptic seiz ure itself. Hugh

that the great tendency of

ch ildhood to react upon

temen t, is due to the fact

ofchildren is in the firstand in the second is under

reatise on Tetanus is

auer. He considers i t inte tanus as an inflammation

,

was formerly done. The

the cord do not support

are al so too inconstant .

single form of disease, but the same changes are

found in connection with very different diseasedconditions. In certain s tages

,tetanus may be con

founded with cerebro-sp inal meningit is,even wi th

tubercular basilar meningitis,and both give rise to

stiffness ofth e neck . But in the two latter thereis rarely trismus

,and the accompanying symptoms

ofboth would prevent any prolonged mistake.Catalepsy is treated ofby Professor Eulenberg.

The etiology ofuncompl icated,id iopathic cata

lepsy is almost enti rely unknown . Eulenberg

assumes that catalepsy belongs to the large class ofdiseased conditions designated by G reisinger cons ti tutional neuropathies

,whereby its n ear connec

tion with other neuroses Of this group,hysteria

,

insanity, epilepsy, and chorea is indicated and also

that a predisposit ion dependent upon congenitalpreformat ion ofcertain portions ofthe central nervous system generally precedes the appearance ofthe catalepti c attack . Professor Eulenberg treats

also in th is volume oftremor, paralysi s agi tans, andof an affection somewhat resembling paralysi s agi

tans that he designates At/zetosz'

r. This affectionwas first described by Hammond in 1 8 7 1 as a com

bination ofsymptoms somewhat resembl ing paralysis agitans

,th e chief characteristic ofwhich is a

ceaseless motion ofth e fingers and toes,which

does not permit them to remain in any positi on in

which they are placed Hammond supposes the

seat ofthe affection is in the intercranial gangl ia orupper portion of the spinal cord. Chorea, is taken

by Professor Von Ziemssen . The dance of St. "

Vi tus made i ts firs t appearance as a wide spread

mental disorder in the second half of the four

teen th century in the neighbourhood of the R hine.

Under the magistrates’ orders those affected wereled in troops to the chapel ofSt. Vi tus, that theymight be quieted by process ions, masses , &c.

, &c.

Subsequently th e name chorea St . V it i was extended to the sporadic cases ofspasmodic movements ofthe body. To Sydenham is due the con

ception ofchorea as now entertained, and the separation ofi t from the foreign element, th e termthen being applied

,ofthe chorea m inor sive Anglo

rum in contradistinction to the chorea major siveG ermanorum . Von Zeimssen considers that thegroup ofsymptoms called chorea major is not adisease su i g ener i s but is only the product ofgenuine psychosi s and cerebral maladies on the one

hand,and ofhys teria and wilful sim i lat

'

on on the

224

other. The other subj ects treated ofin this volume are Hysteria by Prof. Jolly,and DisturbancesofSpeech by Prof. Kussmaul . The latter is amost recondite and learned d isquisition .

THE SC IENC E AND AR T OFSURGERY. By JohnEric Erichsen

,F.R .S ; Eng , Prof. of

Surgery Clin . Surgery, University College.Seventh edition improved, enlarged and illustratad with 862 wood engravings. Two volumes.Philadelphia : H . C . Lea . Toronto : WillingWill iamson .

This work is so long andfavourably known tothe profession

,that noth ing more is n ecessary than

the simple announcement that a new volume of th is

standard work on surgery has been issued from the

press . I t cannot be spoken oftoo highly,both as a

text-bookfor medical students,and a work ofrefer

ence for the practical surgeon . We have often had

occas ion to consul t th is classical work and never

have been disappointed either in the matter ofad.vi ce or suggestion which it contains . I t should be

in the hands ofevery medical practitioner.A TREATI S E ON PRAC TICAL AND ANALYT ICALCHEM I STRY, by F. Clowes

,London .

I l lu strated. Second London edition. Philadelph ia : H . C . Lea. Toronto : Hart R aw

lingson .

This work is intended to furnish a course ofinstruction on practical chem istry in publ ic andother schools . I ts obj ect i s tOgive al l necessarydirections

,so fully and simply

,as to render almost

unnecessary the services ofa teacher. The de

scription ofthe different apparatus and how to useth em

,i s given in the fullest manner

,and yet the

siz e ofth e work is kept with in very moderatel imits.

SC R I BNER ’S MONTHLY,FOR 1 8 78

We invite the attention ofthe C anad ian publ icto S cr ibner”: M onthly ,

which has a large circulation

in England, and now,at the beginning ofi ts eighth

year,deservedly ranks among the best il lustrated

periodical s ofth e world. During the past year

several papers have appeared in S cr i bner”: m on t/zly

devoted wholly or in part to Canada. During the

year 1 8 7 8, there wil l appear beautifully i llustratedarticles on Caribou-Hunting , Moose-Hunting, SealFi shing

,The Thousand Islands

,etc. , etc.

,besides

a charming paper by John Bu rroughs, enti tled,“ Following the Halcyon to Canada. CANADAANG ET and Scribner’ s , in advance .

THE CANADA LANCET.

SYC O S Is— priz e essay for 1 8 7 7 ofth e B ellevueHospital Medical College Alumni Association

,

by A. R . R obinson , M . B .,L. R . C . P . AND S . ,

Edin ., New York . New York : D . Appleton

C o.

CL IN ICAL R EPORT ON 3873 EYE PATIENTS , .treated at the New York Ophthalmic and AuralInstitu te, during the year 1 876. By Dr. Ad .

Alt, M . C . P . S . O .,Toronto ; ( late resident

assistan t Surgeon to the above Inst itute . )

ON THE DRES S ING OFSTUMPS .— Old method

Lister’s antiseptic plan —the Bordeaux treatmen tofstumps, Burow’s plan mod ified by the author— comparative statistics , by Louis Bauer, MD . ,

M . R . C . S .,Eng ,

St. Louis .

WHAT ANZESTHETIC S HALL WE U SE - by Prof.Jul ian J . Chisholm ,

M . D.,Bal timore .

EXC I S ION OFTHE LOWER END OFTHR R EC TUM ,

IN CAS ES OFCANC ER— by John B . R oberts,M .

D., Philadelphia Sherman Co .

R ETARDED D ILATATION OFTHE O s UTER I INLABOR— by Albert H . Sm i th . M . D . Philadel

phia.

A DOC TOR ’S COUNTER-IRR ITANT.—The pre

scribing druggist — P nnc/z.

fitti ng,“

g an isms, Quaint.

On the 9thFeb. at Orono, the wife ofDr.THERFOR D, ofa daughter.In Toronto

,on the 20th ult. Dr. E . M. HODD

aged 6 7 years .

In Montreal on the 29th ofJanuary, Dr. R .

MAC DONNELL,from injuries received wh i

ing the funeral ofth e late Dr. Peltier.

w z

'f/z t/ze canm zn n z’

catz'

on .

THE POPULAR SC IENC E MONTHLY AND ITs S U PPLEMENTFOR FEBRUARY , 1 878.

These favorite j ournals have come to hand ,and as usual are full of valuable informati on

,

Among the numerous articles this mon th wewould. call especial attention to “ The EvolutionTheory and i ts relation to the Philosophy ofNature

,

”

by Prof. Haeckel, and“ The Liberty ofScience in

,

th e Modern State,” by Prof. R udolf Virchow. Dr .

Pettenkofer has also an excellen t paper on “ TheHygienic Influence ofPlants.”

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THE CANADA LANCET.

a course is Open to question . On the other hand ,i s i t not their privilege, aye, and duty, to class ify andutiliz e the knowledge already gained ? Many

th ings may be truewhich are comparatively valueless.

To know the facts i s important, bu t a further effortand patience in the pursu it oftruth are required toascertain which are the most valuable . The l inemust be drawn somewhere. Probably were we to

attempt, at present, to dis tinguish between the

different methods practiced in ovariotomy,no two

investigators would be found agreeing in every par

t icular. This supposition ju stifies the expectat ionnow indulged, that the ,

subj ec t chosen for discussion this morning will prove interesting and

profitable to all present.

The d iscussion ofovarian disease— i ts diagnosisand various methods oftreatment

,i s not designed

in’

this paper but the diagnosis hav ing been made,

and ovariotomy decided upon,i t i s proposed to as

certain which are the most successful , and con se

quently the most useful methods o f accompl ish ingthe various steps ofthe operati on . The plan proposed is to give a resum? ofwhat the writer believes to be the best methods now practiced, and

to assist in el iminating a mass ofrubbish which atpresent encumbers the l iterature ofthis procedure .A desire for brevity

,and the intention to avoid

,an

passanz‘

,a discussion ofthose points which may be

more advantageously considered at th e close of the

paper,must excuse the peremptory manner in

wh ich the writer’s viev‘

vs are occasional ly expressed .

PREPARATIONSFO R THE OPERATION .

The operat ion should be undertaken only by

that surgeon who real iz es the full weight oftheresponsibili ty he assumes

,and determ ines to

be thoroughly prepared for every s tep ofthe proced iIre, as well as any emergency that i s l iable to

occur for, unquestionably, success greatly depends

upon the preparations previously made, the care

and skil l exercised during each stage ofthe operat ion

,and particular ly the vigi lant supervision given

to the minutiae ofthe after-treatment. When

possible, choice should be made ofa pleasant andheal thy local ity, and of a large and cheerful room ,

capable of being heated and ventilated. The

room should be thoroughly cleansed,the ceiling

wh itened, the walls cal cimined or newly papered,and the wood-work and how well washed

,using

plenty of soap and water. The carpet andfurn i

ture should be new, and the bedding clean.

wi l l be found convenient to have two beds,nearly al ike as possible, in the room,

so that

patient may be easily l ifted from the one to the

other. The patient having,after a full and candid

explanation to her ofth e possibil i ties of the Operation ,

‘

volun tar ily decided to avail herself ofthi sprospect ofa radical cure, th is question ought tobe regarded as settled ; and from that hour all dis

cuss ion on that point entirely avoided, while everymeans should be employed to inspire her with

hope and courage. In the absence of'urgent

symptoms,t ime should be taken to improve her

physical condition,and elevate her vital powers .

She should be kept free from

nutri tious and easily dig

and the kidneys secretnormal urine. A few days preced ing '

the op

tion,she Should occupy her lying-i h room , and

treated as an invalid. The evening before, or the

morning ofthe operation , the bowels should bethoroughly evacuated by a sufficient dose ofCastorOil

,after which

,on account of the l iabil ity to sick

ness from the anaesthetic, no sol idfood should beallowed. A kind

,in tell igen t, and experienced

nurse should be secured— one who will faithfully

and tenderly attend the patient, and maintain a

firm yet gentle discipline over the room . I t is

obviously impracticable to decide , with absolute

certainty,U pon a fine day for the operation , as has

been recommended,with the wind in a certain .

quarter. The choice has to be made some days

previously,and no ordinary weather-prophet can

calculate with much certain ty the state ofthweather two or three days hence. The patientprepared

,the nurse and assistant on hand, and

everything being in readiness, it would be exceed

ingly inconvenient to postpone the operation on

account of a rainy day, or an east wind. TheOperator should have a written list ofall the ins trumen ts and utensils usually needed , includingthose rarely required in any emergency, this l ist

should be checked,and the instruments properly

arranged on the table,convenient to h is hand.

One hour previous to the op eration , the patientsh ould receive th irty drops of laudanum , and im

mediately before the anaesthetic, a li ttle brandy andwater. The anaesthetic administered, the as

ants enter the room , theshould be maintained at

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table ,sheets

,

abnud

legs should be kept

n stockings,flannel

The feet rest upon

fthe table. I t i s ne

have five or six skillful,cool -headed

free from al l ta in t or su sp icion ofconaris ing from dissections

, posfmar tenzs ,ns

, or contagious diseases . The nurse

in readiness, i n the room,plenty ofhot( I to 1 00 ) a

soap,towels

,soft

and cotton cloths,napkins

,&C . She

ave thre e pairs ofnew spongesfl read i ly

shable from each other : one pairfor th ewound the second

,a large pair

,for the

ofthe tumor ; and the th ird pair, extrafine, for cleansing the peritoneum . Care

keep each pair in separate dishes,

who sponges the contents oftheponges re

ght ofth eoppos i te.shou ld be

h is dut ies , and ready to ant icipate the

operator“

. The ass is tant in charge ofC should be accustomed to its adminone who could be rel ied upon to faith

e h is duties regardless ofthe progresshe anaesthetic should be given

y as is necessary to maintain

This is importan t,owing to th e ten

prolonged s ickness and vomit ing after

y. When chloroform,which I prefer

,

i s as tonish ing how l ittle i s required to

complete anaes thesia,especially when

gut tatim upon on e thickness ofamou th , held closely

e loss ofvapor,while

All things being in readiness,the bladder should

be evacuated with a cathe ter by an assistan t,before

commencing th e operation .

THE ABDOM INAL INC I S ION .

The abdom inal section is now a lways made in

the median l ine,between the umbilicus and sym

physis pubis,the length required depending some

what upon the nature ofth e contents of thetumor. Even for explorative purposes th e inc is ion should be abou t five inches long

,which will

u sually be found suffi cient to al low ofthe extractionofthe tumor after i ts s ize has been reduced

,but if

not, the incision can afterwards be l engthened .

The section is made with a strong s calpel,com

mencing below the nave], at a poin t which will

make a proper l ength ofwound ending an inchabove the pubic symphysis. Care must be

taken to make the dissection along the

median l ine,through the skin

,areolar and

adipose tissue,down to the li nea a/ba. When this

i ena’z'

non s l ine has been reached,and uncovered

throughou t the extent ofth e external wound,i t is

p iCked up by a tenaculum , opened, a groved

director passed underneath,and carefully avoiding

the sheath ofth e rectus muscl e on ei ther s ide,th e

aponeurosis is divided along the l inea alba,from

end to end. One more structure— thefascia transversalis with some adipose tissue, having been

Opened in a similar manner, th e peritoneum is ex

posed . A l i ttle time should n ow be taken to

sponge th e wound and arrest the hemorrhage. The

peritoneum is then raised hy the tenaculum,snipped

,

and divided upon the director. A small quantity

ofs traw-colored serum now usually escapes from

the lower end ofthe wound , and occas ionally, ifnot prevented by an ass istant controll ing the upper

end,a loop ofintestine wil l protrude . Themritoneal

cavity having been thus opened , the tumor is brought

into view,and in most cases presents the bluish-white

,

gl istening aspect characteris tic ofan ovarian

tumor,bu t in some instances, especial ly compound

cy sts, the appearance is darker, redder and more

vascular. I n other cases a Ioop ofin testine mayfirst present itself ; the great omentum readily re.

cognizable by its characteris tic ad ispose appearance,may

,l ike an apron, extend over the tumor ; or a

very vascular membrane may cover i t, which on ihvest igation proves to be hypertroph ied proj ections

of th e pedicle , con tain ing large blood vessels.

J ; ‘l’

228

1Some ofthese unexpected complications are very .embarrassing to some operators

,in the excitement

ofthe hour, but a cool , quiet investigation wil l soonserve to clear up the perplexity

,and the experienced

surgeon will prove h imsel f equal to th e emergency .

ADHES ION S .

The tumor having been exposed to view,search i s

made for adhes ions. The hand is washed , plungedin to warm carbol iz ed water, and two o r three fingers are passed around between the tumor and theabdominal parietes . I f sligh t adhesions are met

with , they are gently broken down w i th the fingers.I have found the

.

large curved steel sound,re

commended by Professor Thomas, an excell en t in

s trumentfor a more extended search for adhesions .It i s warmed, dipped in the d is infectan t , and passedgently around the tumor as far as the pedicle .With the aid ofthis harmless instrument th eOperator can satisfactorily assure h imself ofthepresence or absence ofadhesions around everypart of the tumor excepting posteriorly. The

most serious adhesions met with,are strong at

tachmen ts to the bladder, u terus , omentum ,and

intestines . These bands mus t not be cut,unless

first secured by a silk l igature and this,I believe ‘

to be a good and safe method. But i t is usual to

enucleate them from the tumor by the fingers orthe handle of the knife . Another excellen t

method ofseparating strong adhesions,i s by

making use ofthe temporary clamp and actualcautery. When , however, th e cyst is firmly ad

hereht to the bladder,intestine, or u terus , a small

portion ofthe cyst wall should be cu t out and leftadherent to the viscus

,the secreting membrane

being dissected away. In such cases great caremust be exercised to avoid perforating the intestine

,

or rupturing the fragile wal l Of the cyst.o TAPPING THE C YST.

The Operator having confirmed h is diagnosis,

and ascertained that the removal ofthe tumor ispossible, proceeds to diminish its siz e by removingthe fluid contents. The cyst is seiz ed at th e

upper end ofthe abdom inal'

inci s ion by strong,

toothed , or deeply grooved forceps , and steadied ,while the large trocar is plunged in to i t . An excellen t instrument for this purpose is th e trocar

,

known as Spencer Well s ’. I t is an ingen ious contrivance, self-retain ing , and has a flexible tube at

tached , through which the flu id is conveyed into

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town,a large tube

,sloped and pointed at one end ,

may be improvised for th e occasion,an opening

being made for it by a scalpel . In such an event,and indeed in all cases where there is danger ofthecontents escaping into the peritoneal cavity, H i s

best to turn the patient on her left side , wh ile the

fluid is flowing away,and every precaution mus t

be taken with sponges and flannels to prevent the

contents getting into the peritoneum . In the mean

t ime,the assistant is k eeping the cyst well into the

wound , by steady traction with the forceps, while

another compresses the abdominal walls agains t the

tumor by one hand on each side ofthe incis ion .

Incompound tumors after th e parent cyst has been

evacuated,others come into view

,and are, one

after another tapped and emptied . The contents

of some cysts are very gelatinous and tenacious ,passing out through even a large tube very tardily .

Under such c ircumstances , the patient being on herside

,I have expedited their evacuation by laying

them open freely with a scalpel . In other cases ,the contents are semis ol id

,or composed mostly

ofsmall cysts— honey-combed , which have to beincised

,broken down with the hand inside, and

scooped away before the cyst can be suffi cientlyreduced to be extracted through a fair siz ed

opening .

REMOVAL OFTHE TUMOR .

As the cyst i s be ing emptied of i ts contents, theassistant

,by continued traction with the forceps ,

gradually withdraws the lessened tumor through

the incision,assisted

,i n most cases

,by the hands

of the operator. Care is now taken to have the

tumor wel l supported by the assistants, to preven t

i ts fal l ing, or dragging inj uriously upon the pedicle .

When the length of the pedicle wil l perm i t, i t i sgood practice to tie it tightly with whip-cord, n ear

the tumor,make a loop with the cord, with wh ich

to manipulate the ped icle, and cut away the tumor.Th is may be now entrusted to a skillful and experienced ass istant, who wi l l attend to any un

ruptured adhesions,according to the methods

v iously described, while the Operator gives h iattention to the pedicl e .

S EC UR ING THE PED IC LE.We come now to the most important step of th

operation— the treatment of the p edicle.

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OVAR IOTOMY BY ENU C LEATION.

allow ofsecuring i t wi th a double l igature . This

happy though t enabled me to complete the opera

tion sat isfactorily,and the result was successful .

I therefore feel indebted to Dr. Miner, for giving

his valuable discovery to the profession .

Dr. Miner’s remarks were reported in the

Transactions of the International Medical C on

gress,and may be abbreviated asfojlows

It i s well known that the ovarian tumor i s surrounded

by a peri toneal covering ; that the ped icle , p roper, usuallyd ivides into three orfour parts , pass ing up over the walls ofthe tumor in band s ofvar iable w id th , which con tain vessels,often oflarge siz e , and wh ich gradually d im in ish in thicknessand in the siz e ofthe con tained vessels , un t i l finally they arelost i n simp le , th icken ed portion s ofperiton eal covering .

The peritoneal investmen t i s not closely attached to the cyst ,but separates read ily, just as the p eritoneum separates e lse

where in the pelvic cavity, be ing immed iately lined by the

subserous ce llular tissue thus no vessels ofany consid erablesize enter the cyst. The tumor separatesfrom i ts attachmen ts w i th remarkable read iness , so much so that, in severalinstances , i t i s reported to have escaped the grasp oftheoperator , andfallen spon taneouslyfrom the ped icle by acci

d ent, thus plainly ind icating the natural and proper method

ofremoval . The accompanying cut,1

'from a d raw ing byDr . Edward N . Brush, who has several times assisted m e

The fingers ofthe operator are represen ted b eneath a

cular portion ofthe ped icle, separating i tfrom the'walls of

the tum or.”

As for securing the pedicle by the less valuablein Operating, W ill g ive a veryfair idea Ofthe Proceedut e methods— acupressure

, écraséur , th e galvano-cau

S ee Append ix C ase II I .‘l'K indly loaned by Dr . M iner.

tery, or by twi sting and torsion, I shal l not take

up your time in discussing,as they possess no

This separation is to be careful ly made,un ti l

‘

the

vessels are traced to their term ination . To m ake

the il lustration plainer, the tumor is represented as

raised from the abdominal “cavity,and supported

by the hand of an assistan t,but

,ofcourse

,where

exten sive adhesions are presen t, thi s i s impossibleand the risks ofremoval are greatly augmented .

Formerly,the operation in such cases was

abandoned . Whe’

n adhesion s exist,they are to be

separated,and the process continued to the pedi

cle . The cap illary vessels thus broken (during theprocess ofenucleation ) do not bleed, for the band ,

contracts,and corrugates the larger ‘ trunks

,wh ile '

the broken offcapillaries ooz e a littl efor only aminute or two

,and a dry napkin

,appliedfor a

short t ime,is all that is required .

”

THE CANADA LANCET.

ut the remaining two methods— th e

and th e l igature— demand especial

C autery .— This method in troduced

Clay, a celebrated ovariotomis t , offor the purpose ofarresting

visceral adhesions,

pedicl e also and with most excellen t

I t con sis ts in compressing the pedicle with

orary clamp while being divided, or rather

by a wedge-shaped cautery iron,heated

a white heat,so as to burn its way slowly

through th e structure. The clamp is then uh

screwed, and after waiting a short t ime, to secure if

n ecessary any bleeding vessel,by a ligature or

another touch ofth e cautery,th e stump is allowed

to recede into the peritoneal cavity,and th e ah

dom inal wound is completely closed . Although

th is plan ofdividing the pedicle yielded unpa

ralleled results in the hands ofth e late Mr. BakerBrown , very few since his lamented death , have

adopted his procedure, except in cases with very

short pedicles,and then only as a daw z

’

ar ressor t.

R ecently, however, one ofthe most bril l iant ovariotomists ofth e day, Mr. Thomas Keith , ofEdinburgh , has practiced this method in over fifty cases,and out of24 r operations , (by various methods ) hassaved 206 1ives— a success hi therto unequalled in the

history ofany capital operai ion .

” But most operators

seem anxiou s to avoid this mode,except in cases

where neither the clamp nor ligature i s appl icable ;appearing to th ink that the danger ofsecondaryh emorrhage decompos i tion ,

and septi c absorption is

increased thereby.For in stance take the followingIn ovariotomy, the great thing i s security again st

hemorrhage and that, I th ink , i s best gained by the use ofthe clamp or the ligature.

”Dr . R obert Barnes , “ Trans

action s ofthe “ International Med ical C ongress , ” ofPhilad elphia. Page 806 .

ent work on th e Diseases ofWomen

,says

“ Mr . Baker Brown introduced the p lan ofamputatmgthe tumor by means ofthe actual cautery, and claim ed theaston ishing resu lts oftwen ty-n ine cures in thirty-tw o ope ra

tions . The insecurity against hemorrhage attendan t uponthe method w il l p robably p reven t i ts competing with thosealready m entioned , bu t in certain rare cases i n wh ich the

part to be amputated i s deep with in the pelvis , it offersgreat advan tages .

Schroeder, in h is recen t work, page 42 2 , remark sas follows

The actual cautery is especially recommended by Baker

The g reat s t reng th ofDr. Ke i th lies in the thorough p reparat ionofh i s cases , and in the care wh ich h e takes W i th them pe rs onally I amread y to use any me thod that the cas e may d emand .

” Dr. AlexanderR . S imp son , ofEd i nburgh , at In te rn at ional Med ical C ong ress , Ph i lade lph ia. page 80 7 .

Brown . The fear that the gangrenous eschars , replacedw ithin the abdom inal cavity may excite periton itis , seems tohave littlefoundation . The reproach i s better grounded

that cauterization does not surely p reven t subseq uen t hemorrhage, especiallyfrom the large vessels and the comb inationofligature with cauterization ofthe ped icle seems to involveserious danger , because gangrene ofthe ligated portion more

read ily occurs under these circumstances .”And very recently

,in a cl in ical lecture on th e

treatment of the pedicle in ovariotomy,Mr. Chris

tOpher Heath , made the following statement

I have emp loyed it (the actual cautery) in several ofmycases w ith good effect, but I do not think it so safe as the

ligature for however careful you may be to cu t the ped icleslow ly w ith an iron , no t too hot, so as to sear the cut edges

thoroughly, there is always the risk ofsom e small vesselsb leed ing and requiring a ligature , and sometimes the burn tedges becom e separated and the b leed ing i sfree . I t i s ex

actly the d iffe rence between applying torsion to a largeartery and putting on a l igature w ith the last, onefeels pe rfectly safe, whilst w ith theformer something m ay go wrong .

”

On th e other hand,Mr. Thomas Keith after his

large experience with th e cautery , gives i t as h isopinion that

It i s a good m ethod and one which has had scan t justicedone since Mr . Baker Brown ’s death .

“

Apart,however

,from Dr. Keith’s large experi

ence,nearly al l ovariotomists agree that the cautery

method possesses great advantages in certai n

cases,especially when the pedicle is very short and

deep with in the pelvis . The only conclusion,i t

appears to me,deducibl e from th is reasoning, is ,

that if the cau tery method offers great advantagesin certain diffi cul t ca ses

,i t would answer even

better in al l favourable ones .

The Lz’

gamra— The most approved manner ofsecuring the pedicle by th is procedure

,consists in

passing a strong double l igature , made ofsi lkthrough the cen tre ofth e pedicl e near its root, witha probe or large needle, dividing the loop and

tying each hal f separately, and as'

ah extra pre

caution passing one ofthe ligatures t igh tly aroundthe whole pedicle the ligatures are all cu t offshort

,the pedicl e divided hal f an inch outside of

the ligatures,th e stump dropped into the pelvis,

and the abdominal wound a- solu tely closed. This

method of tying and dropping ,” according to Dr.

Peaslee,one ofthe best authorit ies on these ques

tions,was practised in New York over fifty years

ago . But to the late Dr. Tyler Smith,belongs the

honor,at al l events

,of reviving and populariz ing

the method,he having had a series ofmost successfu l

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cases .* Tyler Smith used Indian hemp ; MarianSims, s ilver wire ; and others various other agents ,such as horse-hair, catgut, whip-cord &c. I t was

claimed that catgut, being an animal substance and

absorbabl e, would prove to be more effectual thanany other agent but experience proved that it wasl iable to sl ip and become untied

,and consequently

it fail ed to meet the expectation ofits advocates.Gradually the good, old -fash ioned , silk l igature ,i tself an animal product

,has become the favorite

for this purpose ; strange to say, however, whatever ligatures are used, i t is imposs ibl e to find them

afew months afterwards,and the question is

,what

becomes of them ? I t has been suggested that

they become partially if not entirely absorbed

but the experiments ofSpiegelberg,Waldeyer

,and

Maslowsky, on the horns ofth e u teri of animals,prove that not only the ligatures

,bu t also th e

stump beyond them , become encapsuled by effusedlymph . _ It is claimed for this intra-peritonealmethod, that i t is simple , easy ofadapt ion

,ap

taking and skillful operator,who gives personal and

great attention to the details of the preparation , andafter treatment ofh is patients , wil l yield aboutequal resul ts and , consequently, i t does n ot mat

ter much to which method recourse is bad , pro

vided i t is wel l executed and rece i ves the same

vigilant supervi s ion .

I t is highly important,therefore

,that the opera

tor should be unprejudiced— not wedded to any

particular plan ; bu t that he should proceed to

each case prepared , and desirous to adopt thatmethod which, under the circumstances, seems

best adapted to that particular case.

To be con tinued.)

SECONDAR Y UTER INE HE MOR R HAGE.

BY A. D . M ILLER, M .D . ,NEW DUNDEE

,our .

Allow me space in your valuable j ournalforpl icable to al l pedicles

,and admits ofthe immediate notes Of an alarm ing case Of secondary uterine

closure ofthe abdominal wound in i ts whole length .haemorrhage WhIC h I had the m i sfortune to en

That the “ tying and dropping ” method is a good encounter in my short experience in practice.

and successful one,and gradually coming into

popular favor, i t is needless to dispute ; indeed , i t

is easy toforesee that i t is destined,ere long

,to

become thefavorite procedure.Having given as much space to the considera

t ion ofthe best methods ofsecuring the pedicle,

as a paper ofthis kind will permit,i t is now onl y

necessary to make afew remarks by way ofend eavoring to draw the l ines a l ittle closer than

has here tofore been attempted . We have seen

that there are two methods worthy of commenda

t ion T/ze ex tra and the infra-

per i toneal.

We have seen that the extra-peritoneal method is

best accomplished by means ofa clamp,s ecured

external to the abdominal wound,and the intra

peritoneal method, by either enucleation , the actualcautery, or the s i lk ,

l igature ; nei ther method ap

pearing to possess advantages superior to theother.

The conclus ion that forces i tself upon the writeris, that either method, well-performed by a pains

I am myselfi ncl ined to the use ofthe ligature , and Inow again refer to Dr. Tyler Sm ith ’s m ethod oftreatingthe p ed icle as the best ofall m ethods, and the one to wh ichall others w ill, in my op in ion , ere lon

'

ve lace.

”— Dr.E . R . Peaslee .

g gl p

Mrs. Ma fi aet . 24. Canadian,s trong con stitu

t ion . Weight about 1 1 0 lbs. F irs t confinementdiffi cult child expired on 2nd day. From her description subinvolution probably existed. Her

health was poor until after h er second confinement,

which was quite easy. Tolerably heal thy afterwar ds, bu t womb ( to use her expression )

“ siz e ofgoose egg, up near the navel and pointing forward.

”

During her third pregnancy she suffered from lameness of the left leg

,and considerable pain in the

breasts at n ight.

On the 24th ofOct. , 1 8 7 7 . I was summonedto attend her in her th ird confinement. Labor

difficul t as the legs were becoming paralyz ed,

uterine pains strong and child making no advance,

I delivered her by instrumental aid (forceps )Child still born , and seemed as if it had been dead

for some time. Weight of child nearly 1 2 lbs;d imensions ofhead

,b i-parietal

,diameter 5 inches, occi

pito-frontal 5% inches, occipito-mental 6% in.

Had I not seen the case,I would not have be

lieved that so smal l a woman could have givenbirth to so large a child

,without mutilation .

Oct. 28612. Well as could be expected uterus

apparently large but not tender on pressure discharge natural .

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THE C ANADA LANC ET.

continued ipecac. and acetate ofl ead, and addedquin ia and acid sulph . aromat.

l eft/2. Stil l improving.

z or/z. Continues to improve, lowered foot ofbedto level.22nd . Feels quite comfortable. Discontinued

appl ication ofi ce, and ordered a mixture ofiron ,quin ine and acid sulph . aromat. From th i s t imeshe continued to gain rapidly

,and to-day (Feb .

i s able to perform a considerable portion ofherhousehold du ti es

,and her cheeks have regained

their wonted rosy tint.

R EMAR Ks .—The occurrence ofhemorrhage in

this case seemed to be due entirely to an atonic

condition ofth e uterus. Query ? Was atony

caused by previous subinvolution , displacemen t,over-distension from carrying so large a ch ild

,or

severe u terine contraction P In no instance does

the practitioner require greater coolness and pre

sence of ‘mind than in such cases as these,for the

life oft he patien t depends upon prompt and decisive action .

TWO CASES OF MATER NALIMPR ESSIONS.

*

BY H . M. MAC KAY, M .D., WOODSTOC K , ONT.

CAS E 1 .— Mrs . B th e mother ofa fine

healthy boy was during her second pregnancy much

affected by the sight Of a hand with two thumbs oni t. I t so shocked her, that she became anxious

and ful l ofdread , l est her own unborn child shouldbe similarly deformed . Having attended at her

confinement,and not knowing anythingabout her

alarm,she surprised me after the b irth of the child

by asking,Are the hands al l righ t ?” On exam in

ing,I found on on e ofthem a supernumerary

‘thumb,ofnormal siz e, growing from the dorsum of

the metacarpo-phalangeal articulation ofthe natural one. In every other respect the child was

perfectly formed and well developed.

CAS E 2 .— Mrs. H mother of several healthy

children,was severely shocked during the preg

nancy referred to in th is report by a sad acciden tto her husband

,and which afterwards proved fatal .

To make the case more intelligible, I will first*R ead before the C ounty ofOxford Med ical Association

January 3 I st, 1878.

relate the accident referred to. Mr.pump-maker

,was engaged in a well at

ofth irty-five feet staying a pump, whenwalls suddenly gave way. The stones

,

partial arch over h is head,prevented

1

weary labor,

audible al l the time,he was found still l iving, with

his arms and legs clasped around the pump-log, a

pos ition into which he sprang,as he afterwards

s tated,when he fel t the stones moving. When

taken out, cold and numb , his feet were turn ed

i nwards as in the act of climbing. Two stones had

pressed upon him, one on the head left a contusion ,

the other,on

duced a slough . He l ived only fi ve days after the

acciden t . During thi s time he was very restless ,bu t much rel ieved when some person leaned over

him so that h e could clasp his hands around them .

Mrs. H six months advanced in pregnancy,

a deformed infant,the abnormal ities ofwhich bore

a striking resemblance to th e condition and marks

on th e father, produced by the accident in the

well . Its feet were turned inwards,with doubl e

tal ipes varus'

ou the side ofthe head was anecchymos is , ,

and in the lumbar region ofth e spinea wound differing from an ordinary spina b ifida

,in

their being no abnormal fluid in the subarachnoidspace

,and besides th e spinal processes and laminae

ofthe part, all th e structures external to the membranes ofthe cord were deficien t. The cord of

normal siz e was visible through the membran es .

The wounds on the head and spine corresponded

to those referred to on the father, more especiallythe latter

,as a slough when removed leaves exposed

th e normal structures underneath . The child livedfive days, the same length oftime as the fatherl ived after the accident . Another

,and the most

remarkable coin cidence,was that the child resen

'i

bled the father,in not resting, only when some one

held its hands firmly grasped . The latter circum

stance I could not bel ieve unt il I saw unmistakableevidence ofi t. As I entered the room one day

the child was sleeping qu ietly,the nurse holding

i ts hands enclosed in her own .

me the pecul iarity,and as I e

being doubtful of th e fact,sh e

THE CANADA LANCET.

ofbeing “ explained as an

for there does not ofmece sbetween the fact of ‘ the

hand with two t humbs on

11 ch ild being born with a

no more than probabl e that they stand to

other in the relation ofcau se and effect.do th ink that the laws ofprobabili ty wil llow ofa similar in terpretation in my secondwere th e five points ofresemblance .h ild turned in l ike those offather when

wel l ; inj uries on head and backwith those on father ; l ived five

disposition to have the hands supstituting a cha in ofevidence notOver. I fel t the greater confidence

latter case before you,knowing that

here present, Dr. Millma‘

n,saw it

,

doubt but that h e remembers the

in England,and al so

p ro. and ( on so It the cases of suffi cien t interest to be brough tthis Association.

E OF OVAR IAN DISEASE WITH AB

S C ES S IN COR R ESPONDING ILIACR EGION .

J. R . HAM ILTON , M. D. C . M., STRATFORD, ONT.

Mrs. E a married woman aged twenty-nine

and the mother Of two ch ildren,the youngest

three years of age, consu lted me at my Offi ce1 sth ofOctober

,

’

7 7 , in reference to a uter

for some

consulted

s that of

tric region . I n making a cursory examination I

found the pulse only sl igh tly accelerated,and the

heart and lungs normal . When making a vaginal

examination next day I found th e 05 lower in the

vagina than natural,the lips hard and contracted .

On open ing the 03 with a large catheter th ere wasa quantity ofpus escaped

,and I was given to un

derstand by the patient that th is discharge was of

frequen t occurrence,arid was always followed by

temporary rel ief. Where th is discharge came from

I could no t wel l make ou t,not being ofa carcin

omatous nature,and there being noth ing to indi

cate an intra-mural abscess. For some time I doubtedth e patien t (who was inclined to be hysterical ) buton making examination subsequently

,I found the

same discharge when the os uteri was opened. I

prescribed ton ics and an opiate every n ight as she

rested badly. She con tinued in this way for a.

time, expressing herself somewhat rel ieved ofpainand able to walk to my office occasional ly untilthe 26th December, when sh e .was compelled to

remain in bed , and on the 28th I found her with a

very rapid pulse , tendernes s O f abdomen , vomit ing,tympan ites, pinched features, and al l th e symptomsofperitoneal inflammation . I prescribed Opiates

,

fomentation s, &C ., but sh e remained in this state

and gradually sank and d ied on the 5th inst.Autopsy fifteen hours after death . Drs . Hyde

,

R oe, and Hanavan who had seen the case werepresent to assis t me in making the post mor tem .

On opening the cavity ofthe abdomen we foundthe small vessel s of th e peritoneum inj ected and thegreater portion ofthat organ highly vascular. We

found th e uterus very small and contracted,bu t

without any trace oforganic disease. The cavi ty

Of the abdomen on the left s ide as wel l as the pel

vic cavity on th e left side were fi l led with pu s. We

found th e Fallopian tube and ovary ofth e righ tside in a healthy condi tion the Fallopian tube onthe left s ide was also normal , but the l eft ovary

was almost completely gone,a collapsed cyst being

allthat remained , and that surrounded and imbedded

in pus,the only outlet for which to the os that

we could find must have been through the left

Fallopian tube. The seat ofabscess must havebeen in the ovary in the first ins tance, but the rec

tum as wel l as the sigmoid flexure ofthe colon werebecoming involved the l iver and other organs ofth e abdomen as well as the contents of the thoraxwe found in a normal and heal thy condition .

236

ON SIMULATED ONE-SIDED BLINDNESS,

AND HOW IT MAY BE DETECTED.

BY ADOLF ALT, M .D. , TORONTO.

LEC TU RER ON O PHTHALMOLOGY AND OTOLOGY, TR INITYMED IC AL S C HOOL.

In countries where every healthy man is forced

to do mil itary service, i t often occurs that youngmen try to evade their m il itary duty by simulatingone-sided bl indness. A great many methods have

been devised,therefor, to detect such simulation .

This was the more necessary since there are cases

ofreal bl indness, of which we are not able to d etectthe cause by th e ophthalmoscope. I t is , however,not the mil i tary service only, which induces people

to such simulation,and there are a number Of reasons

why one-sided bli ndness may be simulated in th is

country as well as in any other,for instance in

actions at law with a view to obtain a large amount

ofdamage for an inj ury etc. I t thus would seem

to be necessary for the general practit ioner,to be

acquainted with at least some of the speediest

methods, of arriving at a correct opinion ofthecase before him .

The most common way to detect simulated one

sided blindness,and one which is wel l known , is by

placing a strong pri sm before the pretendedly

heal thy eye,thus producing a double-image. This

tes t,though perfectly rel iable with an individual

who does not know of its application,is nearly

worthless now, sinc e most of the s imulators knowi t. The same appl ies to the test with a stereoscopewhich is based on th e same principl e.A very s imple test has been taught lately by

Knapp . He makes use ofthe movements oftheeye in monocular and binocular fixation . F irstleave both eyes un covered

,and move an obj ect

(your finger) towards and from the individual’s face

and direct h im to follow it s movements with h is

eyes. If both eyes keep their usual ax is wellfastened upon the obj ect and follow it well

,neither of

them can be blind . Then you may alternately

cover and uncover the alleged bl ind eye,wh ile the

other one is fix ed upon the Obj ect offixation .

the former, when quickly uncovered at once moves

towards the object offixation and fastens itself upon

'

i t, i t cannot be bl ind, because a bl ind eye wouldnot take part in the act of binocular fixation.

The same idea l ies at the base of the method

THE CANADA LANCET.

appl ied by von Welz . He places a prism of about

base outward,before the alleged bl ind eye.

This will produce ofcourse,a double-image. In

order to overcome the disagreeable feel ing of seeing double the individual will turn the eye under

the prism towards h is nose,i f i t is not bl ind . If

he is thus caught,we may catch h im again by tak

ing the prism qu ickly from his eye .

‘ I f th is eye

now turns outward again to get rid ofthe now exi st ing double-vis ion, the eye is doubtless doing i ts

duty.

A very ingenious method is that ofCuignet. Hetraps the s imulator by letting him read from a

book and placing a rod, about an inch broad, be

fore the heal thy eye in such a wav that i t intersects

a l ine from this eye to the book and nearer

the former. I f the individual now reads quietly

on wi thout moving the head,he mus t read the

letters which are covered'

by th e rod for the

heal thy eye,with the pretendedly bl ind one.

Most recently Snellen published a new test,

based on the perception ofcolours . He tests the

d efaultor with test-types of al ternately red and greencolour

,after hav ing placed a green glass before the

sound eye. If the other one i s actually blind, he

w ill see the letters ofone colour only the red ones,if the letters are prin ted upon a white

,th e green

ones only if they are upon a black background.

Some time ago I'

was ordered in my position as

surgeon to the German Army to examine a young

German with regard to his fitness for m i l i tary service. After I had examined h im and declared his

pretended heart-disease a falsehood,he insisted up

on his being blind Ofon e eye. The s imple testby watching the movements of the eyes in monocu

lar and binocular fixation proved that a l ie also .

To make it more certain,I used a method which to

my knowledge has not yet been described. He

decidedly knew the test with one prism . I thereforplaced two strong prisms with their bases together

and these before h is heal thy eye i n such a way,that the united bases crossed the centre of the pup il,and directed h im to look at a candle about 1 2 feet Off.He apparently d id not know, how to get out ofthe

I f affair now and after some hesitat ion he acknowledged to see three images. Two of these, ofbelonged to th e healthy eye and were due

different refraction ofthe two prisms, wh i(the middle one ofthe three) belongedalleged bl ind eye .

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THE CANADA LANCET.

numerous societies,would require a comparatively

smal l number ofmed ical men 2) the publ ic wouldlose the serv ices ofthe ablest men

,for as a rule i t

would be only second or th ird class men who wouldsubm itu to the humil iating terms imposed by thesocieties: (3 ) the rapid decay ofmedical science, andthe lowering ofthe social status ofth e profession .

This scarcely requires proof ; i t is sel f evident

What professional man that entertains even the most

modest estimate ofhis j u st claim to the respect andesteem ofhis fellow men , would consent to placeh imsel f in a great degree at the mercy ofeverynoisy demagogue belonging to the society.” Oncehe accepts the appo intmen t

,every member wil l

have a voice in his dismissal,and therefore he is

forced to pander to the ignorance and prejud ices ofall. His bread and butter depends on h is subserv iency. The medical men wil l come to occupyvery much the status ofthe R uss ian clergy

,who

are more the slaves than the rel igious instructors of

the gentry, and even ofthe m iddle classes. All

th is will necessarily lower to a lamentable degree,

th e l iterary and scient ific standard ofthe whole profess ion as a body. Much more may be said,and

ought to be said on this'

subject, but I feel that I

have already trespassed far too much on the spaceallowed to correspondents .

Yours truly,

Feb . 1 2th, 1 878 . ONE OFTHE PROFES S ION.

AFFILIATED MEDICAL SCHOOLSTo the Ed i tor ofthe C ANADA LANCET .

S IR ,-In the issue of the LANC ET for February

,

I noticed a paragraph to the effect that the TorontoSchool ofMedicine has been advertised forth e past three years as the Medical Department

Of Victoria Col lege,Cobourg. I was much sur

prised at th is statement,and have been at some

pains to look into the matter,and have been much

struck with the following facts of which sooner or1ater some n otice must be taken by the Senate ofthe Univers ity ofToronto . On page 25 oftheVictoria College calendar for 1 8 7 7 , will be found

the following

“MED ICAL DEPARTMENT— PROVINC E or ONTAR IO .

Students intending to graduate in Victoria Universi ty

,are recommended to attend lectures in the

Toronto School of Medicine,from wh ich school

certificates ofattendance wil l be accepted by themedical examiners of this Un iversity.

”

Then follow the names of the different membersofthe Faculty ofthe Toronto School of MedicineDrs . Aikins ,Wright, R ichardson , Ogden , Thorburn ,Barrett

,O ldrigh t, MacFarlane, &C .

, &c. At the

close of the announcements in the medical faculty,the calendar says Additional information may

be obtained from Dr. Aikins,President ofthe

Toronto School ofMedicine .”How a pious Methodist

,l ike Dr. Aikins, could

say in the face of this,in his letter to the Lieut.

Governor in Council,asking for the d isaffiliation of

al l medical schools connected with the TorontoUn ivers ity with a view to a re-arrangement,

“ that

the students ofthe Toronto School of Medicinecan avail themselves of the degree ofth e TorontoUniversity on ly

” is a mystery. (See R eturn No.

3 2, 40 Vic. 1 87 7 , pageSome may not be aware ofthe fact that th is

school being thus advertiz ed is in direct contra

ven tion of, at least one of the conditions ofaffiliation lately laid down by th e Toronto Un iversi tyand which are the same for every affil iated school ,and ofcourse equal ly Obligatory upon all . The

cond it ion thus con travened is the first resolution ,passed June 1 2 th , 1 8 7 7 , by the Senate ofthe University ofToronto, and is as fol lows — R esolved

'

firstly : “ That no medical school or college should

be admitted to,or continued in affi l iation, which

is,or becomes, connected with another Univers ity,

either as i ts medical faculty, or by its professors or

lecturers being examinersfor the degrees , honors,scholarsh ips, or standing, ofanother University,or i ts nola

’

z'

ng on! i n any way that its exam inationswil l be accepted by another Univers ity, as ent itl ingto degrees

,honors

,scholarships, or standing

Provided that this shall not preclude any one, or

more individual professors or lecturers bona fide

becoming examiners in another Univers i ty— th eintent be ing

,that the faculty of any affi l iated col

lege, or any part thereof, shall not be permitted to

substantially conduct the examinations of their own

students for degrees,honors

,scholarsh ips, or stand

ing in another Un iversity.”

Any school applying to be affi l iated shall beinformed ofthis regulation , and shall be requiredto enter into an undertaking to observe i t, subj ectto the express cond i tion that upon breach of suchundertaking

,th e statute shall be repealed and

'

afli liation cancelled .

”

Yours respectfully,M .E.

,TORONTO UN IVERS ITY.

March 13 th , 1 8 78 .

THE CANADA LANCET.

WESTER N R AILWAY MEDICAL

TAR IFF.

To the Edi tor ofthe C ANADA LANC ET.— Iftoo much space has not already beenup in discussing th e subj ect of the Great

relation

letter regarded the

commercial point ofview. I pro

at i t from a medical s tandpoint.

conduct of the profession be towards

company who,by adopting a cutting

s h imself in antagonism to the tariffby the Divis ion Medical Associa

which have adop ted a

d on a dollar as the

visi t to a patient.

has been conceded

man and man,but i f

Society wil l take the

with the n ew regime

will not average fi fty

out ofwhich they have to pay fora malarial district such as the rail

rough near Windsor where quinineuired , i t would be simply imposs ibl e

company ’s prices. The phys ician

to use cheap drugs,h is

ld be delayed,and ins tead of

would be an z'

znprovid en t

are, as a rule , well informed

rs they will very soon dis

v ictims ofe/zeap tr eatmen t.advantage s ofth e society’s

i e treats the head ofcalled in when other

This is the point

Windsor, March , 1 878.

To the Ed i tor ofthe C ANADA LANC ET.S IR ,

-In th e March number Of your j ournal,a

case of poisoning by arsenic is reported as havingbeen treated by dialysed iron .

After relating the h istory, he says I admini stered the emetic and promoted vomiting by large

draughts ofwarm water. After the s tomach hadbeen thoroughly emptied , I gave a tablespoonful

of dialysed iron , diluted with water, which was

take such a stand as will prote ct my own Interests,and by so doing place mysel f in antagonism to my

brother practi tioner P In other words, am I going

to extend the etiquette ofthe profession to a manwho is taking away my practice

,by a system of

ebony charges 2 I trow not.

You state the case correctly,when you say that

the medical profession has i tself to blame for this

state ofth ings,by its members encouraging clubs

and societies to benefi t themsel ves,principally at

the expense ofthe doctor. I t l ies with medical menthemselves to say whether they shall stand by one

another and secure an honest fee, or l end them

selves to clubs,societies

,and l ife assurance com

pan ies , to perform the work upon which th e very

existence ofthese organizat ion s depend,for the

insignificant fee usually offered. The very spirit ofth e medical act , and the code of eth ics instituted

under i t, are violated the whol e tendency of

medical associat ions which seek to foster and secure

fraternal conduct, is defeated by the introductionofsuch elements ofdiscord.

Mr. Broughton has no very decided opinion ofth e motives which induced 26 out of 28 physician s '

to accept the pittance offered by th e society. I

can tell h im that h e wil l find the true explanationofi t in the spontan eous desire on the

'

part of

medical men to aid any good work— not stopping

to enquire into its merits—w together with their

general apathy abou t making money,attributes

wh ich serve to make the profession in Canada,

and perhaps the world at large,poor

,where they

might be rich ; th ese motives, I say, wil l furnish

th e true reasons for the hearty,though ill-considered

response he met with in call ingfor medical ass i stance on such beggarly terms .

Yours very truly,

THE CANADA LANCET.

rej ected in afew minutes . He then goes on to

describe the symptoms ofcollapse,with the treat

ment adopted to combat them,and concludes by

attributing the woman ’s recovery en tirely to the

dialysed iron .

”

Now,Sir

,inasmuch as h e adm its that no iron

( the antidote) was administered until the stomachhad been entirely emptied ofi ts contents, I wouldl ike to knew in what way he supposed the ironacted.

Yours very truly,

MED I C US .

O ttawa, March 1 1 th,1 8 1 8.

PILIFER OUS SEBACEOUS CYST .

To the Edi tor ofthe C ANADA LANCET.S IR -I enclose you a short account of a case

which to me at l east seems worthy ofinserting inyour valu able j ournal . In November 1 8 76 , a youngman

, J . R came to my office wishing me toremove a tumour about the si z e ofa hen ’s egg

,

s ituated over the mastoid portion ofthe temporalbone, beh ind the left ear. He says i t has been

there for the las t 1 4 years, and as well as he can

remember grew to i ts present siz e in a few weeks

without any previous cause being assigned. I t has

given h im no inconvenience since,only its appea

rence it i s conical in shape with a broad base andgives a soft gangl ionic sensation to the feel . Oncutting d own upon the tumour which I endeavoured

to remove intact, I found it to be cystic in charac

ter, fi ll e d with a white sebaceous looking matter ofa soapy consistence

,mixed up in which were numer

ous black hairs from 9 to 1 2 inches in length looselyco iled round in the cyst

,and ofthe same colour

as the hair ofthe patients h ead. As the cyst wal ls

were very friable,and blood was flowing pretty

freely, I broke it up well, evacuated i t throughly,and fi lled the cav i ty with l int soaked in carbol ic oi land allowed i t to d ischarge freely for 4 or 5 days .At the

’

end ofa couple ofweeks i t had healed completely wi th no trace whatever, save the scar.In the fi rs t week ofj an . 1 8 73 , two years s ince

first removal , he returned again , i t having reappeared

he says about a year after the first operation , andattained its former siz e in a coupl e of months . I t

looked similar in every respect to the one before

mentioned, but was somewhat larger. Owing to the

before I found it utterly impo

cyst unbroken , th e matter 00

tained the same peculiar bl

evacuated the contents I got h

cyst and carefully dissected i t

found that the inside presented a well formed

aneous su rface with a soft velvety feel and was very

thickly studded with black hairs proving to my

surprise that they had actually grown from the

inside. None ofthose attached were longer thanfrom an inch to an inch and a half

,as al l the

long hairs were lying loosely in th e matter unat

tached . The case seems to me un ique there was

no history ofprevious inj ury or anything to accountfor the abnormal growth ofhairs within the cystwalls .

Yours respectful ly,D . O ’BR I EN

,M .D .

R enfrewFeby. 24th , 1 878 .

S chema gunmen.

CASE OF TR AUMATIC TETANUS R E

C OVER Y.

BY A. LAWS ON , LOND .

,PROFES S OR OF

SURGERY,HAL I FAX MED I C AL S C HOOL. N .S .

The following case is probab ly sufli ciently 1n

teresting to be placed on record.

G. S a fisherman ’

s son,ten years ofage,

l iving at Sambro, a v il lage about twenty miles fromhere, on August 1 st, whil st runn ing barefooted,accidentally ran against a scythe

,receiving a wound

about two inches long on th e instep ofthe left foot,

which impl icated the extensor tendons alsoanother on the l ittle toe ofth e same foot, nearlysevering the toe. He was brough t to Hal ifax .

Sutures were inserted and the wounds dressed. Hethen went home to Sambro. On August oth I sawh im for the first time

,and found him in the follow

ing condition —The jaws were firmly locked therisus sardonicus wel l marked whole body stiffenedwi th decided Opisthotonos great diffi culty in swal- llowing and breathing ; sweating profusely ; pul se144 temperature The wound ofinstep wasgranulating health ily

,th e stitches hav ing evidently

sloughed out,and a small piece of bone was pro

trud ing from the l ittle toe , which I removed. The

poor boy was l i terally covered with poultices,all

the windows religiously closed,and a fire in th e

stove, altough i t was a very hot day in August. ifpeculiar nature ofthe contents ofthe former tumour left in this condition much longer the boy must

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THE CANADA LANGET.

people. The struggling in this case was ofthatcharacter noticed in persons addicted to stimulants .In either robust or alcoholic indiv iduals is i t righ tto continue the administration boldly ? Most emphatically, No. The Edinburgh school may boastofimmunity from death by their method

,but I

th ink t heir health ier patients and the purer air mayexplain much ; but whatever i t be , no one whoadministers chloroform to a purely London cl ien telebut wil l be driven by experience to give it mostcarefull y . The patient should be moved as l ittleand as gently as poss ible while under an anaesthe

t ic, and also during recovery . In this case therewas no excessive movement the operation was onth e foot the patient had plenty of air. In operations about the jaw, in add ition to the dangers consequent on the part

,I have seen a diffi culty arise

from the pressure on the chest,of instruments

,or

a casual elbow or hand. Sylvester’s method ofart ificial respiration is the best

,w i th this mod ifica

t ion grasp the arm just above the elbow,instead

ofat the wrist. The reasons are obvious and therespiration Should not exceed twenty-five per minu te . When sufli cient assistants are present the artificial respiration can be much more efficientlyperformed by two- one standing on each s ide ofthe pat ient

,and working one arm apiece. This is

better than only one behind the head the assis tan t that pulls forward the tongue and keeps thelower jaw forward can then stand at the head.

The tongue should be well pulled forward unt il theentrance and exi t of air to the chest can be heard.

The legs should be ra ised at righ t angles to thebody ; th is assis ts the circulation , i s an improvement (without interfering w ith the Sylvester) onthe “ hanging up head down plan (wh ich , however, i s good in the case ofchildren) , and i n ad

diti on relaxes the abdominal walls . There is no

doubt ofthe efficacy of nitrite of amyl on th e circulation it is now prepared in hermet ically sealedcapsules, which can be Obtained suffi ciently strongto carry loose in the waistcoat pocket.broken only one so carried during the last twelvemonths .most useful . I think the strength and frequencyOf the pulse after resuscitation on th is occasionwere entirely due to the amyl . Should the patien tnot come round in six or seven minutes

,I should

recommend immediate tracheotomy or laryngot

omy, as I think the air passing direct through thetube is a stronger stimulant than when passingthrough the normal passages ‘ warm and alreadyimpregnated with chloroform vapour. I f ice behandy, a piece put in the rectum can do no harm,

and has been already noticed as of avail i t interferes in no way with the rest ofthe process . Ifthe heart stil l continues beatless after the inhalation ofthe n itrite ofamyl , I should feel incl inedto puncture the pericardium

,so as to reach the

apex ofthe heart with the electric needle. This

being unsuccessful,the substance may be pierced.

In no case ought artificial respiration to be relaxedunti l the above measures have been tried, when ,if th e patient has undergone a very serious operat ion and a long anaes thesia

,I trust the operat ing

surgeon will always share the resul t with the ad

min istrator of chloroform — M ed ical Times and

G azette,Feby .

ON PAR ACENTESIS OF THE PER IC AR

DIU M WITH A SUCCESSFUL CASE.

BY WILL IAM PEPPER,A.M .

,M .D .

,

Prof. C lin . Med icine , U n iversity ofPennsylvan ia.

l

GENTLEMEN You wil l remember that in conn ec tion w ith two cases of pericarditis of moderateseverity

,which formed th e subj ect ofa lecture

several months ago,I referred to a desperate case

ofpericarditis, with effusion , in which i t had beennecessary to perform paracentesis. My ch ief ob

ject to-day,in returning to the same subj ect, is to

report at length the latter case,and to make afew

practical remarks in connection with that operation .

Sarah C . , set. 1 7 , a well -developed girl , enj oyinggeneral good heal th

,had noticed since May

,1 87 7 ,

some shortness of breath on exertion , especiallyafter mounting the long fl ight ofstairs lead ing tothe fringe factory where she worked . She hadalso been obl iged “to pass urin e more frequentlythan usual . She had never mentioned e ither ofthese symptoms to her parents

,fearing that they

would make her stop working. In early ch ildhoodshe had passed through a mild attack ofmeas lesbut had never had any other exanthem or

rheumatism . On Sunday,September 2

,she suff

ered with praecordial pain. NO cause could beI have assigned for the attack

,unless i t were that she had

Ibeen chilled by a draft wh ich blew upon her as sheThose con talmng five drops are the worked. On Monday the pain continued w ithsome sense ofOppress ion . She did not leave the .

house , but it was not until Wednesday, September5 , that she became qui te suddenly so ill as to confine her to bed

,when she was seen by Dr. George

R ex, with whom I saw the case in consul tation

,

and to whose courtesy I am indebted for many ofthe facts in connection with it. He found herwith a very moderate degree of fever

,but with

some anxiety and d istress,and with rap id pulse

,

frequent breath ing, and severe praecord ial pain.

By Friday, September, 7 , she was much worse.There was stil l severe praecordial pain with greatrestlessness and distress. The respiration was

very frequent and much laboured. The pulse wasextremely rapid, feeble, and irregular. The apexbeat of the heart was felt with difficulty

,and the

THE CANADA LANCET.

n,with a sense of suffo

approaches her. I t wastau tly. The respirationsa t least 1 45 very small

,

The pupils were dilated ;us the intell igence clear.

The paroxysms ofalarming dysp noeavery frequen t. On physical examinat ion

lesion of the lung was found. The praecordiawhat prominent . The impulse 'Ofthed neither be seen nor fel t

,and its sounds

ly audible, be ing d istant and feeble , and

On the other hand,Hoffman ’s anodyne gave some

rel ief to the paroxysms. During Monday andTuesday (September 10 and 1 1 ) she grew worse, ifposs ible

,and had several sligh t convulsive at tacks .

I saw her again with Dr. R ex, late on Tuesdayn igh t. She was then dull and l istless , with l ividl ips and cold extremit ies . The respirations weremere shallow gasps 7 5 to 80 in the minute. Thepulse was over 1 00

,extremely thready and inter

mittent. At times,also the respirations were dis

tinctly oftidal character,ascending and descend

ing with marked intermissions . Each paroxysmofdyspnoea seemed as i f i t would prove fatal ,and it seemed cl ear that death would occur beforemorning. The consent ofth e parents being ob

tained , I immediately performed paracentesisofthe pericard ium with the assis tance ofDr. R exand ofC . B . Nancred e. The smallest needlepointed canula of Dieulafoy’s asp irator was employed

,with a vacuum jar. The puncture was

made in the fifth intercostal space,abou t on e inch

inside of the l ine of the left n ipple,z'

. e., nearly in

the normal position ofthe apex-beat. The needl ewas introduced in a d irection upwards and inwards.As soon as i ts extremities were fully covered by thesoft tissues

,the communicat ion with th e vacuum

jar was Opened,and the needle was cautiously

pushed onwards . When th e l iqu id began to flowinto the jar

,and the poin t ofthe needl e was felt to

be free in the pericardial sac,th e needle was di

rec ted somewhat downwards and outwards . R athermore than eight fluid ounces of reddish serum wereremoved

,after which the flow ceased . The serum

contained a large proportion of albumen,many

red blood globules,and a large proportion of

pseudo-fibr in . No d iffi culty whatever was eu

countered ih the operation . Once or twice the poin tcame in contact wi th a fi rm and apparently roughened surface , which was probably the apex ofth eheart

,coated w i th lymph . The effect ofth e oper

ation was magical . The pul sefell to 1 14, becameregular

,and much more ful l. The respirations

soon fell to 40, and became much more deep andregular. The apex-beat of the heart could befel t,though stil l feeble and t :>o high up . The cardiacsounds became imm ediately much more distinct.The l ips grew more red

,and the express ion

improved vastly. She expressed hersel f as feel ingmuch better, and able .to l ie qu ietly. She was ordered iodide of potass ium gr. v. and t inctu re ofdigitalis gtt. x

,each every four hours . The die t of

skimmed milk was continued. There was no evi

dence of any return of pericardial effus ion , and fortwo days she continued very comfortable , althoughthe urine was stil lfaintly albuminous . On Friday

,

S eptember I 5 , two severe convul sions occurred ;the mind grew dul l the respiration again becamerapid

,and tidal in character and the pulse inter

mitten t. On September 1 6 she continued in apartially uraemic state, with several convuls ions.

THE CANADA LANCET.

Stil l no sign ofincreased pericardial effusion oc

cu rred ; but, on the other: hand

,the area ofdul

ness progressively diminished,and the impulse

and the sounds became more distinct. On theevening of this day an enema of infusion of j aborandi (5j of powdered leaves in giv water) wasgiven . The effects were rap id and marked violen theadache

,repeated vom i ting, copious sal ivation ,

and drench ing sweat, lasting six or seven hours .She passed a more qu iet n ight, and was better thefollowing day. The pulse was now regular

,and

more ful l— 1 08 in the minute and the breathingeasier. The cardiac impulse and sounds more d ist inct

,and sligh t friction sound audible . The use

of digital is,iodide ofpotassium , and d iet of

skimmed m ilk continued .

She had two convuls ive attacks on September1 7 , and on September 1 8

, three severe attacks , inall ofwh ich she was unconscious

,with froth ing at

the mouth,and general convuls ive movements .

The cardiac symptoms continued to improve .There was a trace of albumen in the urine

,bu t no

tube casts could be discovered . On September 1 9 ,a second enema ofinfusion ofj aborandi was givenwith the same prompt and severe effect. No further convulsions occurred. The cardiac symptoms cont inued to improve S lowly but steadily.

There was no severe dyspnoea after September 28 .

She was able to leave bed on October 7 , twenty-sixdays after the operation

,and from that onward

her progress towards recoverywas qu ite satisfactory .

R emark s— It will be seen that in this case the

preservation of life was solely due to the operationof paracentesis . I t seemed abundantly ev identthat, on the evening ofSeptember 1 1 , without immediate operat ive rel ief

,l ife could not be supported

through the n ight. The renal compl ication whichexisted was probably due to th e pericard i tis and

,

after the heart ’s action was l iberated,i t became pos

s ibl e to d eal successfully with the uraemic symptoms . In this connect ion

, i t is interesting to notethe great value ofj aborandi. We have in th is remarkable drug a new agent ofvast power for th erelief of such symptoms. After the operation

,

there was not the least sign ofany return ofpericard ial effusion

,and

,although i t is probable that

adhesions have formed,there are no evidences at

presen t that the heart’s act ion is embarrassed bythem . S O far as the original d isease is concerned

,

i t may be said that a complete cure was effected .

The subsequent attacks of subacute peri toni t is,and

ofplastic pleurisy indicate a constitutional characterfor al l of the success ive affections of the serousmembranes

,and I fear that i t may prove that they

have been tu .berculous 9‘

You wil l,of course

,perceive that at the basis of

these practical ru les l ies the quest ion Of an accurated iagnosis. Fortunately

,in the vast m aj or i ty of

cases,th is can be made without serious d iffi culty.

I t ‘ is indeed true that errors in d iagnosis have been

made even by skillful and experienced observersbut in such cases i t will be found that very unusualcomplications or anomalous cond itions existedCertainly, if the case is an acute one, and has beenunder observat ion while the effusion formed, an ac - 4

curate diagnosis can readily be made . Nearlyalways there wil l have been a friction sound ofcardiac rhythm

,and this may pers ist

,especially about

the base,even after considerable increase in prae

cordial dulness from effusion has been developed.

Then,carefully repeated percussion w il l show at

firs t extension ofdulness about th e base ofth eheart

,but soon th is wil l be followed by a change in

the shape ofthe area ofdulness,which assumes a

rudely triangular form w ith its base downwards ,together wi th a decided extension ofthe area. Ifpercuss ion be practised both when the patient is inthe sitting and in the recumbent position , scarcelyany difference wil l be observed i n the horiz ontall evel of the dulness

,but if the patien t be turned

firs t to one side and then to the other,i t will often

be found that the area ofdulness,without changing

its shape , has some mobil i ty from side to side.The position of the apex-beat ofth e heart wil l alsobe observed to change as the effusion occurs ; i tbecomes raised more and more

,and then becomes

lost, though sometimes an obscure sense ofshockcan be fel t over the praecordia after a dist inct card iac impulse can no longer be detected. Thesounds Ofthe heart become marked ly feeble, distant, and obscure ; and the centre of the ir greatestintens i ty may be observed to vary from i ts normalpos it ion . In addition , there may be found, incases of very large effusion

,prominence of the

praecordia,sl igh t bulging ofthe intercostal spaces

over the heart,and even fluctuation on palpation .

Ifthe case has been under observation from the beginning, and careful attent i on has been paid to theabove s igns, a large pericard ial effusion can scarcelyescape detection— unless

,indeed

,there should

coexist pleurisy with effus ion on both s ides,or on

th e left side alone. In th is event i t would probably be imposs ible to decide as to the presence orabsence ofpericard ial effusion until th e l iquid hasbeen w i thdrawn from the left pleural sac by aspiration . If the combined effus ions were not sufficien tly extensive to cause symptoms demandingoperative interference , th e ord inary treatment forpleurisy would suffice while if such symptoms d idappear, as in al l probabil ity they would, i t would beproper to tap the pleural sacfi rst

,after wh ich the

pericardial effusion could be easily recogn iz ed, andtreated as seemed appropriate . The case where thegreatest d ifficulty occurs in the d iagnosis ofpericard ial effus ions are those wh ich come under ob

servation only after the d isease has lasted sometime. Here we could scarcely expect to fi ndfriction-sounds

,and we would be w ithout the

valuable aid furnished by observing the progressivechanges in the extent and shape ofthe area of dul

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246

siz e ofa smal l hen ’s egg. There could be nodoubt it was a traumatic aneurism ofthe anteriort ib ial . I t was resolved to attempt to cure it bymeans ofEsmarch ’s bandage in the manner recommended by Mr. Thomas Smith in THE LANC ET ofMay 26th, 1 8 7 7 .

On December 2nd , at A.M ., a flannel ban

dage was appl ied from the toes to the tumour, anda second bandage from the tumour to the middleofthe thigh , leaving the tumour itsel f exposed .

Esmarch ’s bandage was then appl ied with moderntightness from the toes to the tumour

,and the

patient made to stand out ofbed, in order to fi l lthe tumour wel l wi th blood . Esmarch ’s bandagewas then applied from the tumour to the middle ofthe thigh

,and the th ick india rubber tub ing firmly

fixed above i t. The tumour i tself being stil l exposed

,it was not iced that the pulsat ion in it was

quite arrested,and no bruit could be heard with

the stethoscope. The pat ien t was then d irectedto keep quiet in bed with his leg well raised on

pillows . He did not complain of any pain tilltwelve o’clock (forty minutes) , when he began tohave the sensation of pins and needles in h is footthis pain had became so in tolerable at (onehour after the appl ication ofth e bandage) that ahorseshoe tourniquet was fixed firmly at the groin

,

and the india—rubber tubing and Esmarch’s bandage removed

,th e flannel bandages be ing allowed

to remain . I t was not iced that though the colourreturned to the l imb

,no pulsation could be fel t

either in the tumour or in thefemoral artery. Adose ofchloral hydrate was g iven , and the patien tdirected to keep qu iet. At P .M . a pad of l intwas fixed by strapp ing on the l ine ofthe femoral ,aud

o the tourniquet sl ightly relaxed . I t wasfurther relaxed at P .M.

,and removed al to

gether at 7 R M. The patient was put on a milkand beef-tea diet

,and d irected not to move if he

could possibly help it.There has never been the sl ightest return either

ofimpulse or bru it the tumour has gradually become smaller till now i t cannot be fel t at al l th epower of l ifting the foot returned as the tumourdimin ished in siz e

,and now, in less than three

weeks,i s almost natural . The patient w il l be d is

charged in a few days — TM: Lancet.

PRO STATI C TUMOR R EMOVED DUR ING LITHOTOMY.

—Mr. Bryan t exh ibited specimens of prostatic tumours which he had removed successfullyduring l i thotomy. The first specimen was from aman ofs ixty—seven , who was operated on in Guy ’sHospital in January

,1 8 7 5 , after having suffered

from symptoms ofves ical calculus for eIghteen

months . The blunt gorget was used ; the stonewas caugh t , and found to be large ; a resistancewas felt

,and discovered by the finger to be a pros

THE CANADA LANCET.

tatic tumour s i tuated between the stone and theh inge of th e forceps. The whole was removed,when the calculus proved to be on e inch and ahalf

,in d iameter, and the tumour to consist of

prostatic tissue and muscular fibre. There was nohaemorrhage, and recovery was perfect. The secondspecimen was removed from a gentleman ofseven ty years , who had suffered from vesical symptoms for four years

,and was extremely ill . Lith

otomy was performed the gorget had to be usedand the stone

,when seiz ed

,could not be extracted.

A portion of the prostate was then ascer tam ed tobe in the way, when , by rotation ofthe forceps andpressure backwards on the tumour

,the hinge of

the instrumen t caught the growth,and both i t and

the calculus could be extracted. The patient wasperfectly well in six weeks. The growth consistedofprostatic tissue . Mr. Bryant said that in boththese cases the patients had been rel ieved ofstoneand ofanother cause ofdistressing symptoms by asingle operation . C onvalesen ce was not affectedby the operation . In other words , benefi t seemedto have followed the removal of prostatic tissue.I t appeared to him that in a similar case the surgeon m ight follow his practice

, or even search forthe condition but he would hardly suggest operation for the rel ief ofsymptoms due to enlargedth ird lobe of the prostate. The operation ' hadfirst been mentioned by Sir Will iam Fergusonthirty years ago — M d . Times and G az et/e.

THE COM ING DUTIES OFT HE AC C OUC HEUR.

— Prof. Gai llard Thomas,lecturing on a case of

n eglected prolapsus u teri,makes (M 70 York M en

’

z'

ce/ R ecord,December 22) the following observa

tIon

The time is not distant when confinement caseswi l l be treated very differently from what they areat the present day. This is a subject Of the u tmostimportance. There is the most urgent need ofaradical change in the practice Of the majority ofthe profession

,and the time is ripefor the appear

ance ofa s tirring and abl e paper on The ProperManagement of Natural Labour

,

’ which will awakenmedical men to a sense oftheir duty in obstetricalcases. The physician should be expected and re

quired to visit h is patient from t ime to t ime allthrough her pregnancy

,in order to see that every

th ing is progressing favourably for a successfuldelivery, and to remove , i f poss ible, any condition(as albuminuria ,for instance) which is l ikely to interfere with this and I am fully convinced that itw il l not be long before the accoucheur who doesnot pursue th is plan will be held culpable.Again , he will be held equally culpable if h e discharge his patient at th e ninth day, or at the endOf a fortn ight

,w ithout making a physical examina

t ion , to ascertain that the parts have sustained noinj ury from the strain and pressure ofparturition,and that the process Ofrestoration to the normal

THE CANADA LANCET.

to preven t their outbreak , but there are groundsfor bel ieving that i t possibly may. On the whole

,

Professor Ausp itz’

s resul ts are extremely encoura

ging, and deserving ofserious atten tion .Pre

ven tion i s better than cure is an adage which iscertainly applicable to the treatment ofsyphil isM ed . Times and G azette.

given way. All this could have been readilydone in the second month after del ivery

,and i t

would certainly have been a great deal better to doit than to wait thirteen years before undertakingthe Operation . I t is true that th is woman hassuffered comparatively l ittl e pain and inconveniencein consequence of the neglect ofher physician , bu tth i s i s a very rare except ion to the general rul e '

and , as I said before , th e time i s not far distantwhen the medical man will be held responsibl eforallow ing such a condition to continue without interfering to preven t the evi l resul ts so sure tofollow from i t. — M ed . Times and G az efle.

THE EXC I S ION OFHARD CHANC RES .~ — Pr0fessor Auspitz

,ofV iennafur D erm . and Syp/z.

,has excised the

primary syph i l i tic induration,or hard chancre , in

thirty -th ree cases , as first recommended by Hueterin 1 86 7 , with the following general resu lts — 1 .

In a large number ofthe cases no further syphil it icsymptoms appeared

,although at the t ime of the

operation there was almost invariably indolent enlargement Of the inguinal glands. This fact Auspitz regards as a proof that the init ial sclerosis i snot a pathological resul t ofa pre-existing generalsystemic infection , but a starting-poin t or an or

iginal depfitfor the infective material by whichsyphil is is transmitted . 2 . In those cases whereno secondary i nduration appeared after excisionin the seat ofth e former chancre , there were , as arule

,n o fu rther symptoms Ofsyph ilis. 3 . In some

cases excision was fol lowed by secondary indurationand a general ou tbreak ofcutaneou s and othersyph il it ic phenomena

,but here the probabil ity i s

that ei ther the whole Of th e original chancre wasnot removed , or that th e disease had spread toofar along the neighbouring bloodvessels before excision was performed . 4. In four cases the hardchancre was preceded by a soft sore, and in noneofthese did general symptoms follow excis ion .

5 . The operation can be recommended as a preservat ive measure against general infection wherethe induration has been ofshort duration

,where

no lymphatic glands are indurated but the inguinalglands

,and no other syphil itic symptoms are to ADAM ’

S OPERATION IN ANC HYLOS IS OFTHEbe detected ; and where the chancre is favourably H I P.— This is the th ird ofa series ofcases in whichsituated

,and can be properly dressed and atte nded Mr. Bryan t performed Adam ’s operationfor rel ief

to after th e operation. 6 . Further exid ence i s re Of anchylosis Of the hip . The anchylosis resul tedquired to shew whether excision exercises any in from disuse while suffering from necrosi s of thefluence on th e duration or severity Of the general t ibia. The necrosed bon e was removed Nov. 5 .

syp hil i tic symptoms in those cases in wh ich i t fails 1 875 , ten months after the accident that led to the:

C ZESAR IAN SEC TION .— Dr. J . Braxton Hicks

performed this operation at Guy’s Hospital,upon

a patien t whose vagina was occupied by a scirrhousmass, which involved the rectum and recto-vaginalseptum . The placenta was found beneath the l in eof incision , and the foetal head at the fundus u teri .However th e membranes were reached from thelower end ofthe u terine wound

,th e head se iz ed

,

and brough t out firs t. There was very l ittle haemorrhage. The uterus contracted fi rmly after th eremoval ofth e placenta. The uterin e wound

,

wasbrough t together by in terrupted silk sutures closelyplaced , and a large catheter retained in the u terus ,pass ing through the vagina

,to preven t accumula

tion s and to facil itate injections in case of need.

The ch ild, sl ightly premature was l iving up to lastaccount — fl i rt.

IMPAC TED FRAC TURE OFSHAFT OFFEMUR .

— Mr. Bryant also showed th is specimen . A man

Ofeighty-th ree fell down area steps,and bel ieved

that he alighted on h is righ t knee. I t was foundthat the righ t l imb was shortened four inches theposition Ofth e foot was normal ; and there wascrepitus to be fel t above the knee. The diagnosismad e was fracture in th e lower th ird Of the femur

,

and a splin t was applied. The man died threeweeks after ofuraemia and, post-mortem ,

therewas found suppuration of the kidneys . At thejunction ofthe lower and m iddle thirds Of the rightfemur there was extensive fracture

,and th e proxi

mal portion was driven one inch into the distalportion ofth e bone , causing a second fracture ofthe lower fragment above th e condyles . Mr. Bryan t said that this was probably the only specimenon record ofthe kind ; and that the pecul iar impaction was perhaps due to the patien t’s havingfallen on the distal end Of the bone . The condi tion explained why extension failed to reduce theshortening ; and i t suggested th e advisabil ity ofletting parts alone under such circumstances

,rather

than run further risk, including the danger ofvertical fissure ofthe bone — M ed . Times and G azette,Feby. l 6th 1 8 78 .

THE CANADA LANCET.

disease.The femur was divided on the a3 rd of

th e same month. The following is from no tes onthe case taken by Mr. Poland

November 23 .—Chloroform having been ad

ministered,a smal l incision

,half an inch long

,was

made with a long tenotomy-kn ife above the greattrochanter ofth e left s ide , through the soft partsd own to the n eck ofthe bone, and then with a sawthe neck Of the femur cut through , , and the th ighstraightened . The Sartorius muscle was d ivided atthe anterior superior sp ine subcutaneously

,and the

small wounds covered wi th a pad ofl in t?“ A largeoutside spl int, with foot and cross-p iece, was appl ied

,and a morph ia inj ection g iven , which eased

thep ain , but he was a l ittle sick after the operation .

Both wounds d id well . He compla ined of greatpain in h is back for afew days, but th is soon woreOff.Febr uary 1 0

,1 87 6

— H e was sent down to Bognor

.There was stil l a l ittle discharge from the

right leg.

When at Bognor the wound over the t ibiacompletely closed . He could walk well

,the parts

ab out the h ip hav ing firmly consolidated .

”— T/ze

Lancet, Nov. 1 7 , 7 7 . d i ed . R ecor d .

Excrs10N OFTHE SPLEEN .—Another case of

splenotomy has been pu t upon record by Mr. H .

L. Browne . After all the dangers had beenthoroughly expla ined to the patient

,the Operation

was performed on Feb . 2 3 , 1 87 7 , in the WestBromwich Hosp i tal . There wer e 110 adhesions ,nor was there any d i s t inct ped icle . Four largearteries were met w i th , wh ich were secured bydouble l igatures before div ision

,and also their

veins . There was no hemorrhage . The lad ralliedvery wel l from the chloroform, but five hours afterwards d ied suddenly. There was no hemorrhageafter the operation . The tumor , which was foundto be a simple hypertrophy ofthe spleen, waseigh teen and a half pounds in we ight.No theory Of the cause ofthe d i sease is Offered .

The lad had leucocythem ia. There was no otherglandular affections . The youth of the patient ( 20years) , the almost certainty ofa splen ic tumor be ingn on-mal ignant

,the absence

'

ofother d isease, andthe fact that the pat ient was dying

,and would have

died in a few days from the pressure alone on thev iscera and blood-vessels by the weight ofth etumor— these are some ofthe strongest reasonswhy the operat ion was and should be performed .

Tile Lancet, Sept. 1 , 7 7 . Med . R ecor d .

Two CAS ES OFSTENOS I S OFTHE TR I C U S PIDO R IF IC E, W ITH O BSER VATIONs .

— By R . P . Howard,M .D . Montreal 1 8 7 7 .

—This paper is reprintedfrom the Transactions ofthe Canada Med ical Associat ion for 1 8 7 7 . The first case

‘

ofespecial int erest, having been under the author

’s observat ionfor fifteen years. The patient had chorea when

eight years ofage, but never rheumatism and during l ife the physical signs pointed to mitral andaortic d isease

,and

,finally, tricusp id regurgitation ,

but the tricuspid s tenosis was not d iagnosed . Deathoccu red from cardiac dropsy, and the righ t auriclewas found “ capable Ofholding a good siz ed orange,”i ts muscular walls

,which were fattily degenerated,

being greatly thickened . The tricuspid orificeadm i tted the l ittle finger to the first j oint

,the valve

cusps being united,and form ing a fibrous septum,

This contraction was greater than that ofthe mitralorifice

,wh ich was also funnel-shaped

,and the aortic

orifice was s im i larly s ‘

enosed from cohesion ofthevalve-cusps . The second instance is that ofaheart in the McG ill College Museum ,

and a figureis given in the paper showing the oval tricuspidorifice formed between un ited cusp s . There wasmarked m itral stenosis in th is case al so

,and the

aortic valves were th ickened . Dr. H oward notesthe almost invariable association oftricuspid d lS ‘

ease w ith affections Of the other valves,and he con

tends aga inst the idea that the les ion is ofcongenital origin — Lancet.

SC ARLATINA BY LETTER — Under th is head ingthe newspapers narrate a case in which scarlatinawas undoubtedly commun icated by letter

,from an

infected house td a previously healthy family. Thechildren “ had the envelope to play wi th ,” and tookthe disease . We have

,in T/ze Lancet

,repeatedly

called attention to th is risk . I t is satisfactory toknow that a not uncommon

,but too long over

looked,method ofinfection is at length beginn ing

to be recogn ised. The danger wh ich attends thepractice of wri ting letters

,and send ing papers,

books,and parcels

,from s ick rooms to d issem inate

the germs of d isease ” i s ofno small magnitude.Probably paper, in i ts famil iar forms , i s as effectivea carrier Of morbific material as l inen or wool .The notion Ofdisinfecting books and letters ispractically untenable . Such means of infectionshould be themselves destroyed . Circulatingl ibraries are too often the circulating med ia of commun icable disease — The Lancet.

D IFFERENC ES BETWEEN ANZEM IA AND CHLORO S IS . Zimmermann

,in Zz

’

emssen’

s Cy clopcedza,XVI . , page 50 1 , gives the following : 1 . In chloros is proper the change in the

.blood appears to be

s trictly l im ited to the red corpuscles,whereas in

anaem ia, other const ituents ofthe blood, especiallythe album inates ofthe plasma, are also mod ified.

In many respects the et iology ofchloros is ispeculiar and Obscure and its pathogeny does notadmit ofbe ing traced

,l ike that oford inary anaemia,

to causal factors with which we arefam il iar.The striking effects ofsu itable treatment wouldobl ige us

,even i n defaul t ofother reasons, to

separate chloros is c l in ically from other forms ofanaem 1a.

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250

same professional value accorded to his degree thati t would obtain on the other side

,i . e . ,

enti tl inghim to practice medicine

,surgery

,midwifery

,any

or all ofthem as the case migh t be ; wh i l e if hisqualification only extended to one of these, heshould be allowed to submit h imself to examina

tion in the others at a reduced proportional fee.The same privilege should be granted to those who

have pursued their studies entirely within the l imits

of the Un i ted Kingdom . The question of th e diminution of the revenue of the Counci l ought not tobe considered in this matter at all

,and in point of

fact i t is not probable that the plan proposed would

material ly diminish i t,for th e number of those who

go over yearly is very small,and would not be

l ikely to be much increased by th is con cession .

On th e oth er hand again st the small loss ofrevenue which m ight ensue

,ought to be placed the

advan tage i t is to the country to have i ts med i calmen possessed of th e most extended experience

and attainmen ts possibl e ; the spread ofthatespri t de Corps that m ight be expected to resultfrom the union ofth e profession throughout herMajesty’s dominions into on e body existing under

the same conditions,and enjoying the same priv

i leges , and which ought to distinguish medical men everywhere

,ins tead ofthose ofeach

Province being j ealous ofeach other, and strivingby local rules and regulations to prevent outsiders

from compet ing wi th them . Lastly,th e adm is

sion by Ontario ofBriti sh graduates to registration on the terms here suggested, would open the

way to according similar advantages in Great Britain to those who had obtained the imprimatur ofth e Ontario College.I t must be borne in mind that one great obstacle

to th e recognition ofour diplomas by the BritishMedical Counc i l is the existence ofvaried regulations in d ifferen t Provinces. Melbourne

,for ex

ample, seeks the same advantages for her graduates

that we dofor ours,and throws the same obstacles in

the way ofregistering Brinsh diplomas . The end

desired can only be Obtained by th e assim ilat ionofregulations for qualification everywhere, andshould the proposed conj oint scheme ofexaminationfor Great Britain be adopted at the next meeting ofth e British Medical Council i t may be foundadvisablefor us to mod ify our own regulationssl ightly

,so as "

to bring them into conformity wi ththose contained in i t

,if it be practicable to do so

THE CANADA LANC ET.

Looked upon as they l ie in_the cradle, they ap

pear to be two distinct infants,with their heads

lying in opposite directions,heal thy and ratheI

good looking. On exposing the lower parts, thetwo bodies are seen to blend in one, at the poin

of ordinary situation ofth e l iver of one , and th'

t

spleen ofthe other. The heads, arms, thoracic

organs,and apparently stomachs are d istinct bu1

there is only one umbilicus,and apparently b ut

on e abdominal cavity, on e pelvis, on e sexual apparatus (wel l formed female) , and two legs as

'

i r

ordinary formation. The spine s blend in one aboutthe 1 2 th dorsal vertebra and growing out ofthel eft loin, near th e -pelvis i s a rudimentary arm

genesis of which we have any record on this

tinen t. I t is in reali ty a case ofmonopelvian ,

female children. They were born on th e

ofJanuary 1 8 78 , at th e village ofSt. Benoi t,a midwife only offi ciating. The mother is a y

woman about 20 years ofage,m ild expression

,l ight complexion , and a

nurser. I t is h er second birth . The father

tall man, ofdark complexion , aged about 23

parents are wel l formed,and no such freak o

ture was ever before known in the family.

append the following wood-cu t which gives b

fain t idea of them as they really appear to the

fess ional eye.

THE CANADA LANCET. 25 1

be a leg) having a humerus the metamorphosis into fat in the system. And

part ial hand terminating when unused for th e purposes ofcombination or

esses power of motion , and when i ts change is retarded by the presence ofth ewith the child’s will . Passing small quantit ies ofalochol present, as in lagerspine , i t i s found highly sensit ive beer, ale, &C .

,fat i s deposited and the person be

d . When nurs ing,the ch ildren comes obese . It fol lows then that abstinence

lap so as to be able to take each from water or rather from fluids, generally is th e

at the same time,with th e legs first requis ite in the preven t ion ofobesity, or th e

front ofthe mother, and the reduction of weight , when th is i s desirable. Mentally pressed to the back and bodily activ ity are also unfavorabl e to th e

e between deposi t offat in th e system . But,although lager

beer drinkers and gourmands are liable to form fat ,appear as as do the servants on sugar plantations during the

ying in a sugar season ; yet i t i s well to remember that i t is

other ch ild engrafted on it s not necessary that p eopl e should be beer drinkers

ide, and becoming blended in to one below. to become fat, and that the free imbibit ion of water

are now being exh ibited in Montreal as a is sufficien tfor th e purpose .1 cu ri osity

,and the fatigue entailed may

disastrous to their health,and thu s the

ermay find he has killed th e “ goose that lays HOSPITALFO R INSANE,HALIFAX.

e golden egg by exh ibit ing them prematurely.

PR EVENTION OF OBESITY.

The part which water plays in producing in

ofadipose tissue in the human system canS carcely be over-estimated

,for withou t a l iberal

supply ofth is importan t fluid it is impossible tobecome fat . A liberal supply ofthe carbonaceousel ements Of diet are supposed to induce obesity

,

bu t this would only produce derangement ofth edigestive organs withou t having i t s due effect inproducing fat, unless accompanied by th e needful‘supply of water, and i t wil l be invariably found tobe a

.fact that great water drinkers are pron e to

.become fleshy. This i s the fact with respect to

bo th man and beast. I n fattening animals the'

/more water they can be induced to drink,as every

e easier and more rapidly are they

bservation proves that fat meh and

drinkers ofwater or some8 , and smal l eaters ofsol id food ; onl ean people and an imals are smal l

great eaters .

ing these observations to the human

be readily understood that using the

y ofcarbonaceou s food as i s thepersons, th e additional chemical

flements furn ished by the water,at once facil i tate

We have j us t received th e R eport ofth e Medical Superintendent Ofth is °asylum

,for 1 8 7 7 , from

which we take the following — In hospital I st ofJanuary 337 ; admitted during the year 94 ; discharged cured 48 rel ieved 7 died 25 remaining

in hospital at end Of year 3 5 1 . This gives a mor

tal ity rate Of per cent,and a recovery rate of

5 1 0 6 on the admissions. The recovery rate is

most satisfactory in connection w i th this institution

and has been equally high for many years past.Dr. DeWolfhas been connected with this asylumfor th e past 20 years, and we regre t to learn that

he has resigned the superin tendency in con se

quen ce ofsome charge ofneglect as to measuresto ensure cleanl iness , and dishonesty in the ad

ministration ofrations,

” brough t against the managemen t, as stated in th e report of the committee

of enquiry. Dr. Dewolf posit ively den ies th e

former charge, and if th e latter be tr ue , the com

missioners are to blame. But what Dr. Dewolf

complains ofmost— and he certainly has goodground of complain t— is , tha t h e has not had an

Opportun ity “ of appearIng befor'

e the tribunal

which condemned h im .

” I t can hardly be pos

sibl e that the Government would perpetrate so

glaring an act Ofunjustice as to condemn a manunheard. I f so it must lose al l claims to respect

,

and take the consequences ofth e reaction whichwill certainly be produced , by any inj ustice doneto an old and faithfu l servant.

252 THE CANADA LANCET.

THE TOR ONTO GENER AL HOSPITAL.

The visitor at the Toronto General Hospital ofa few years ago , will scarcely recogniz e in i t the

same institution either in external appearance or

internal appointments offormer years . The BoardofTrustees and Medical Superintendent are to becongratulated up on the high state ofefli ciency towhich the Hospital has been brought, for never be

fore in the history ofth e institution has it been insuch perfect working order. The scheme ofamalgamation which is now being so energetical ly car

ried out will in a short time place th is hospi tal inthefront rank ofinstitu tions ofth e kind on this

continent. The fever Hospital wh ich is beingerected, at a cost ofabout to the west ofthe main building is now rapidly approaching com

pletion and will be ready for occupation in a fewweeks.

The new Burnside Lying-in-Hospital wh ich,

under the amalgamation proj ect i s being erectedin the extreme north-wpstern portion ofth e groundsat a cost of i s also near completion

,and

will be readyfor occupation in the summer. I t is

a handsome white brick bu ilding,with Ohio stone

dressings, and is in a style in keeping with the rest

of the buildings. The Eye and Ear Infirmary to

the eas t of the main bu i lding, i s now about to becommenced . I t wil l cost about This

building will be connected with the main building

by a corridor— the Fever Hospital is ofcourse eut irly d isconnected. All th ese bu ildings are ofthemost modern and improved style

,and every atten

t ion has been paid to heating and ventilation that

skil l and forethought could suggest. The numberofin tern patients in the main bui lding under treatment averages from 1 7 5 to 1 85 , and the number ofextem s average from 20 to 30 per day. Owing tothe increased facil ities for clinical instruction which

the Toronto General Hospital now affords, medi

cal students are no longer attracted to other cities,

because ofsuperior hospital advantages. R egular

daily clinics are given th e year round by the medical offi cers ofthe staff

,the maj ority ofwhom are

connected with one or other of the medical schools .This prosperous state of affairs i s 110 doubt due

to th e able and j udicious management ofthe boardoftrustees. They have boldly grappled with every

difficulty, broken down all monopol ies , and dealtout evenhanded justice to all ; and so long as they

the board ofofthe publ icfrom private

ment are beicredit is also due to the Medical S uperi n ten

Dr. O ’

R e illy, and his able assistants,for th eness and cleanl iness ofthe interior, and the gooorder and discipl ine everywhere manifested.

TORONTO ASYLUM R EPOR T.

This is a carefully prepared report and not

mere mass ofdry figures as is too frequent

case. We have only time and

few prominent points . At the

the year there were 63 1 patie

and 23 2 were admitted during

total of863 as against 956 inThis d ifferenclarge number ofchrothe Hamilton asylum .

the close ofthe yearduring the year were 1 1 2 of these

22 improved , and 1 5 unimproved .

cured and improved is about 42 p

admiss ions during the year. There

during the year, making the rate ofm ortal ity equalto per cen t on the total number ofinmates.‘There is still the cry of wan t ofroom

,

and it is sincerely to be hoped that the Governmen t will secure increased accommodation . I t is

a crying shame that poor unfortunates of th is class

have to be sent to j ail for wan t Of proper aecomm odation in the asylum

,and th is at a time when

medical treatment is ofthe u tmos t coviz .

, at the outset of an attack. Dr. Cl

at considerable length to the alarming

of an enshrouded moral pestilen

words, self-abuse, as one ofth e mostofinsanity. H

this cv

means

issued

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THE CANADA LANCET.

'M ILK OFMAGNES IA.—This preparation only

requires to be better known to be more fully ap

preciated by the profession . It i s a perfec t hydrate

of magnesia,and nOt as many suppose, calcined

magnesia triturated and suspended in muc ilage .

When examined by the microscope it presents a

un iform cloud iness but no particles ofmagnesia areto be seen . I t readily mixes with water, and may

be given alone or in combination with any otherremedy which is not incompatible with magnesia. I thas a perfectly smooth , palatable and milk-l ike tasteand is one of the best antacids whether for .adults

or ch ildren . In the constipation Of infants i t is a

most useful remedy. For acidity ofth e stomach ,either in adults or ch ildren , there is nothing better;i t is easily administered and very efli cac ious. Those

who choose to test it will no t be disappointed in

the resul ts .

THE NEW ANTI S EPTIC THYMOL. -The new anti

s eptic thymol b ids fair to entirely supersede carbolic acid— possessing as it. does superior ant isepticproperties

,and being perfectly innocuous. I t is

.the essential ingredient ofOil Of thyme, preparedby treat ing i t with a s trong alkal ine solution , or bydistil l ing the seeds ofPnyc/zotis aj oroan , an East

Indian plant. Solutions containing 1 part thymol

to 1 000 will completely arres t saccharine fermenta

tion,and only smal l quantities are necessary to

check decompos i tion . I t i s now being used in

G ermany instead Ofcarbol ic ac id in the applicationofLister’s ant iseptic dressings , with marked suc

‘cess.I t is only as an external antiseptic that

thymol is recommended ; i ts internal use has not

an swered the expectations which were formed ofi t.BELMONT R ETREAT.— Thls most excellent pri

~vate Hospital for the Insane , has provided a sepa

.rate department for the treatment of inebriates. I t

i s situated in one of the most beautiful and p ictu

resque spots in the neighborhood ofthe city ofQuebec. The extensive grounds surrounding i t

.are most beautifully laid out

,the build ing is well

appointed,and every care and at tention is bestowed

.on patients ofall grades and classes, by the medi«cal superintendent Dr. Wakeham

,who has had

great experience in the treatment of such cases .

Among the class ofinebriates the cures have averaged about 7 5 per cent. I t is the only insti tutionofthe kind In Canada, and Is deserving of the con:s ideration ofth e profeS S Ion:

gu i shed practitioners, one ofthe ablest tand one ofth e most honorable members.The following resolu tion has al so been

the students of Trinity Medical school by

Gill students medical society

R esotoed ,— That having heard wi th deep regret

Of the death ofDr. Hodder, late Dean Of the Trinity Medical School , whose eminen t services in thecause of medical science and med ical educationare so well known in this country

,we do express

our s incerest sympathy in your loss,and with the

family ofthe deceased in their bereavement .Prof. Osler

,L . D . Mignault,

C /zaz'

rman . S ecretary .

LAC TO PEPTINE.— This preparation

,which is a

composition ofpepsine,pancreatine

,d iastase or

vegetable ptyaline,lactic and hydrochloric acid

,

and sugar ofmilk,is acqui rIng a great reputation

both in England and America,in the treatment of

many forms of dyspepsia,and wasting d iseases of

children. We have used i t in several cases with

remarkably beneficial resul ts,and wefeel certain

the profess ion will not be disappointed in its

effects. I t is also an excellen t remedy in gas trItIs,vomiting ofpregnancy

,dysentery

,and diarrhoea of

ch i ldren . Pepsine is undoubtedly a valuableremedy in many forms ofdyspepsia, but it doesnot seem to meet all the ind ications fulfil led bylactopeptine.

HEALTH R EPORT C ITY OFNEW YoR x .—We have

been favoured through the_ kindness ofDr. Nagle

with a copy ofthe C ity R ecord contain ing the vitals tatistics of the City ofNew York, for 1 8 7 7 fromwh ich weglean th e following. There weredeaths males and females) duringthe year j ust pas t

,which represents an annual

death-rate of24.50 per the estimated popu

lation being Among the d IS eases which

caused the greatest number of deaths , may be

mentioned,zymotic diseases phthisis pul

monalis, diarrhoeal d iseases

, ;nervousdiseases

,pneumonia

,Bright’s disease,

bronch itis,

scarlatina, 983 ; d iph

theria, 95 1 croup, 47 2 whooping-cough, 440.

THE CANADA LANCET. 25 5

died before man tra offin ishes.

before the

20d year ; before th e 3 rd year ; 736 MICHIGAN STATE BOAR D OF HEALTH .

th e 4th, and 5 24 before the end of the sth

r a total of before the end of the 5 th

Of those who reached 100 years and up

there were 2 1 1 5 females and 6 males — a

stance which has been frequently observed,males than males reach th is great

umbe r ofsuicides during the y ear was

males,and 25 females . The report says

“ popular agents resorted to for self-de

were p istols of wh ich there were 49f the latter pari s green

he total number ofbi rths for the year was69

— 1 3 ,o 74 males and females ; or

less than the number ofdeaths.APPO INTMENT — Dr. N . H . Beemer has been ap

phys ician to the Asylum for the

Prior to h is leaving Wyoming

recipient ofan address and presen tation ofseveral articles ofs ilver plate', by anumber ofh is friends as a token oftheir re

gard and esteem . The Dr. carries wi th him the

good-wishes of a large number offriends and acquain tances .

R EMOVALS .— Dr. C . W. C overnton , formerly of

Simcoe,Ont .

,has removed to th is city. His ofli ce

is on the corn er ofChurch and Queen sts . , in th ehouse formerly occupied by Dr . R osebrugh. Dr.

McDonald , ofGuelph , i s also about to remove toToronto

,having rented the premises occupied by

the late Dr. Hodder.

Dr. Stevenson,formerly of L’

O rignal, Ont. , has. removed to Montreal . He was enterta ined at 3.

(15 in and around L ’

O rig

eaving . His Honor Judge Dan

a pleasant evening was spent by

ne long to be remembered.

Dr. Blundell, of London , at thi s announced in the B ri tish medte date . Also that ofDr. Fl eetofDubl in, in th e 7oth year ofDr. L. P . Yandell , ofLouisville ,year ofh is age

,i s announced.

The regular quarterly meeting Of this Board

was held at Lans ing , January 8, 1 8 7 8. Dr. Ked

z ie, President, gave a brief s tatement ofsomeinteresting experiments which h e had recently

made in relation to the permeabil ity ofwalls andcloth ing, and the relat ion ofthe se to the heal thfulcondi tion of houses and cloth ing.

Leroy Parker read a report on a proposed

amendment to a law requiring the transmission

b y the county clerks to the secretary ofs tate, of

the names and pos toffice addresses ofcoroners aswel l as those ofothe r county officers n ow reported .

The proposed amendment wil l enable the state

department and th e secretary ofthe s tate board ofheal th to commun icate w i th these ofli cers

,and to

learn from them the number ofsudden and violen tdeaths

,and the causes Of same

,with a view to

remove the causes when poss ibl e. Mr. Parker

stated that h e had been in correspondence with

the au thorities ofMassachusetts in regard to therecently amended laws ofthat s tate relative tocoroners and coroners j uries

,which seem to be

much better than the law in thi s State,He also

read a report pointing out th e fact that secti on

685 2 ofthe com piled laws of1 8 7 1 makes i t theduty ofsupervis ors to prosecute householders andphysicians for not giving notice ofcases ofdiseaseswhich endanger the publ ic health. The Secretary

reported that circulars had been sen t to corres

pondents, giving details ofplan for making weeklyreports of diseases ; also blanks for the annual

reports Of clerks oflocal boards of heal thand heal th Offi cers throughout the S tate ;blanks were al so issued to meteorological observers

for their monthly reports ; the names and ad

dresses of800 health officers oftownsh ips,28

health ofli cers ofci ties, and 6 7 heal th Offi cers ofvillages have been received ; and six or e igh tdocuments were sent to each heal th offi cer soreported. Most ofthese h ealth Offi cers have beenappointed because ofthe pas t action ofthis Board .

Many ofthem are physicians.Dr. Baker presented a bill drawn by Dr. Folsom

of the Massachusetts s tate board of health , to pr

vent the pollu tion ofstreams by sewers,slaughter

houses,manufactories, etc. The Secre tary s ta ted

25 6 THE CANADA LANCET.

that d iphtheria had been more prevalen t than MED IC AL AS SOC IATIONusual in this and other states

,and suggested that On Thursday, the 3 r st

the board issue a circular on the subj ect. Dr,the medical men ofthe

H itchcock was requested to prepare such circular. the Mechan ics’ In stitute,The causes ofdiphtheria were thoroughly dis pose ofform ing a med ica

cussed,and the opinion seemed to prevail that

sewer gas,dampness, and mould had much to do

in causing i t, although i t is a contagious disease.Dr. Kedz ie made a brief report, giving an ac

count Ofexperiments and tests for th e detection ofPresid ent, Dr.l ead in tin u tensils in common use

,having exam Vice-President, Dr. Bowers , Ingersoll

ined quite a number ofspecimens. He found Pres ident,Dr. Massecar , Tilsonburg

about three-fourths of al l the specimens exam ined Dr. A . H . S . Hill , Woodstock Treas

contained lead in considerable amount. These Millman , Woodstock .

examinations were brought “ abou t by a communi Dr. H . McKay, ofWoodstock, readcation from Dr. Edward Dorsch

,ofMonroe

,Mich .

,ing paper on Maternal Impressions wh ich ,

which had been referred to Dr. Kedz ie as com_having been discussed , was requested to be

mi ttee on Prisons, etc. Dr. Dorsch detai led some l ished in the CANADA LANC ET. The meetin

cases oflead poisoning from the use oftin utensil s. journed to meet in Ingersoll, on the second TThe test wh ich Dr. Kedz ie gave for th is adul tera day in April .

tion is quite simple. Place a drop of n i tric acid

on the tin to be tested, and evaporate to dryness cOUF’C H‘ EXAM INATIONS '— T}fe p

then add a drop ofiodide ofpotassium . I f lead am i nat i on Ofth e Coll ege Phys i c i ansis present

,there will be a yell ow coloration . I f i t Of Ontari o

.

w’n commence on the 29th

is not present the spot wil l remain white . matrIculation exam i nati on W i l l take placeA communication was received from the local 23rd and 24th inst.

board ofheal th in the townsh ip of Minden,Sanilac

county,stating their action for preventing the

spread ofglanders by kil ling and burying a horseaffected with that disease , and that an actionfordamages had been commenced by th e owner of

the horse against the ind ividual members oftheboard .

UN ION MED IC AL AS S OC IATION.—At a meeting

ofth e “ Un ion Medical Association ” held at

Mount Forest on the 1 sth of February, i t was giant and Qtflfllfi.unanimously resolved That it is the opin ion of

0

th is association that the principles ofcontract At Glanford,on the l 0th Feb.

, the wife OfDr.prices with famil ies, secret societies , clubs , or rail Farewell , Of a S OILway companies

,is unj us t to the profession at large

,In Toronto

, on r st March , th e wife ofA. Deand has a tendency to lessen the respect due us La Haye, M.D.

, ofa son .

from the community, and also to l essen th e estimation in wh ich our services should be held by At Tavistock

, on the 1 6 th of January, Jthe public Adams, M .D .

,i n the 36th year of his age.

Also That the charges for ofli ce practice,

In Montreal, on the 2 7 th Feb.

,Dr. Duhame

advice,&C . ,

Should range from to $400,this th e 68 th year ofhis age.

being only an equ ivalent to the charges made by In Bel leville,on the 23rd

other professional men for less important services. M .D., in the 67 th year ofh is age.

Moved that a copy of these resolutions be sen tto the CANADA LANC ET for publ ication .

THOS . K I ERNAN,M .D . ,

S ecretary .

C oR ONER s .-A. McK ay, M . D. , ofInger

soll , to be an Associate Coronerfor the Co. ofO xford .

J . G. Davidson , M . D. , ofWestFlamboro’ , tobe an Associate Coronerfor the Co "

. Of Wentworth .

John J . Farley, M . D.,ofBellevill e, to be an

Associate Coroner for the Co . of Hastings.i

The death ofProf: Wm . Stokes OfDublin, i s announced .

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258

i t has ended , or may arise from the emptying ofpusinto the peritoneum from inflammatory action . Theimportance ofnot only preventing the entrance ofsuch elem ents into the peritoneum , and ofremoving them before closing th e abdominal o pening ;but also ofgiving them free vent during the periodofconvalescence, has attracted the atten t ion ofmany ovariotomists. I t is my uniform habit to inser t a glass drainage tube e ight inches long, andvarying in diameter from half to three-quarters Ofan inch

,j ust above the pedicle and into the depth s

ofDouglas ’s pouch , in eve ry case except wherethere is absolutely no fluid left in the peritoneum .

Should no fluid be left in the abdominal cavity, th istube shou ld not be inserted, or if the operator bein doub t it should be placed in position and keptt ightly corked . If fluid accumulation exist

,or i ts

occurrence be rendered probable by sl ight ooz ingfrom ,broken adhesions, the tube should be left uncork'ed

,

‘ that serum and blood may drain away. Ifno increase oftemperature mark the occurrence ofsepti c absorption , noth ing more is necessary thanto keep this in place until al l danger has passedaway. Should septicaemia show itself, a gum-elasticcatheter cut Offnear its end should be inserted asfar as possible , the glass tube drawn up for an inch,and a stream of warm water containing one drachmOf-c hloride of sodium and sixteen grains of thecrys tals of carbol ic acid to the pint, gently inj ectedby means ofa Davidson’s , or fountain syringe“ Noforce

,

whatever should be employed,but a free sup

ply ofwater should be thrown in, until the returncurren t come forth clear. When the temperatureor puls e

'

ri ses, and the other sympto ms ofsepticaemia develop , such an injection should be practisedonce in eigh t hours. But without the tube is leftfrom the time ofthe Operation , i t is difficult andsomet imes impossible to reach th e most dependentpart of. the peritoneum . In no instance have Iseen evil resul t from this course, and hence I urgeits employment.”

Septi caem ia, which I bel ieve will in time beadmitted to be the most frequent cause ofdeathafter ovariotomy , i s, when once fully establ ished , amosti dangerous state. I t i s ushered in by d iz z iness e xcessive muscular prostration anorexia ;great pallor high temperature small , rapid, andvery weak pulse ; sometimes a low delirium ; drytongue and a sweetish odor of the breath . I t isprobably this condition which is so Often allud edto as a ‘ typhoid istate ’ after Operations

,and one

cannot but suspect that many,if not most, ofthose

cases quoted in Dr. Clay’s tables as shock or collapse

,occurring as late as the fifth , sixth, seventh ,

and t enth days,were really instances of th is affec

t ion . The development of peri tonitis and septicaem ia. should be carefully lookedfor. All t hevital and . physical s igns which mark them shouldbe constantly investigated

,and their inception be

met by appropriate therapeutic means. Septicaemia

THE CANADA LANCET.

being the resul t, first, ofthe decomposition”, andsecond

,of the absorption, of fluids in the perito

neum,i s not l ikely to occur for several days

,but

it may take place in two or three weeks after theoperation . If at any time the temp erature shouldgradually or suddenly advance to or

except just as the patien t rall ies from the immediate effects ofanaes thesia and Operation , fearsshould be entertained that peritoniti s or septicaemiais developing. I f i t occur within four days afteroperation

,it is l ikely to be the former. If after

that time,th e probabil i ties are greatly in favour of

the latter. The pulse will usually become rapid atthe same time whichever morbid condition is developing

,and it must not be forgotten that the two

are often combined. Let no one suppose thatsepticaemia once establ ished becomes irremediable.Experience disproves this ; i t i s th e prolongationofexposure to absorption ofseptic e lements thatconstitu tes the great danger of the condition. Thismethod ofmeeting in an effi cient and satisfactorymanner

,the most fruitful source ofdanger after

ovariotomy,I regard as second in . importance to

no other improvement which has been introducedsince the d iscovery ofthe Operat ion itself. I temanated from Dr. E . R . Peaslee, and has evennow

,I think not assumed it s legitimate posit ion in

the s cale ofi mportance.”This practice has no t been very warmly ac

cepted in Great B ri tain. Engl ish surgeons, pro

verbial for their slowness to adopt any new recom

mendation , have practised drainage only in cas es

regarded as desperate, or l ikely to prove such . On

the Continen t,however, i t has been received

with considerable enthusiasm,especially by th e

thoughtful German . But i t is due to Prof. CarlSchroeder, to say,

-that he doubts the u til i ty oft esorting to the use ofthe drainage-tube in manycases where it is now used. In a recent article

upon th is subj ect he remarks

Let me once more state my views precisely,that the exudation after ovariotomy is not in i tselfthe cause of the septicaemia, but is on the contraryperfectly harmless unless i t decompose ; but that .

decomposition only occurs after infection , and tha tconsequently the important point is not the re

moval ofthe exudation , but the avoidance of theinfection. I should therefore decide upon drainage during the operation , only in case I believed— a state of things which of course should not banp en— that the patient had become infected, or, incase decomposing masses from some suppurati ngcyst

,e. g. had found their way into the abdominal

THE CANADA LANCET.

c ause n or the only symptom ofth e septic condit ion , i t must stil l b e conceded that i ts removal ish ighly desirable. I t i s true

,th is isfirm difficul t to

a ccomplish .

”

C LOS ING THE ABDOM INAL WOUND .

This ‘ is generally effected with both deep and.superficial su tures. Almost every variety ofsuturematerial has been employedfor this purpose. Theresult of the operation , however, does not appear

to depend upon the kind chosen . Most operators

prefer silver wire,bu t Spencer Wells , and some

others , nearly always employ Chinese silk. As the

deep sutures are placed about an inch apart , the

number to be used will depend , ofcourse, uponthe length ofthe incision when the drainage-tube

i s inserted,and the ped icle is brought outside, th ey

should be placed between the las t stitch, and thelas t bu t one . The threads should be about

e igh teen inches in l ength,with a long, straight

needle affixed to either end . Each needle is passedfrom within outwards

,including a narrow margin

ofth e p eritoneal membrane , through th e entirethickness ofth e abdominal wall s, emerging at ap oint about three-quarters ofan inch from thee dge . All th e deep su tu res should thus .be inserted

before any are ti ed . The wound is now examined‘ and ifany fresh ooz ing ofblood have taken place,this must be sponged away. An assistant now

,

with one hand on ei ther s ide ofthe wound,bulges

mp , as i t were, th e redundan t wal ls, while the

stitch es are being ti ed or twisted , Then in order

to secure a n icer coaptation of th e edges of,

the

wound, superficial sutures are placed between the

deep ones, which include only the skin and areolar

t issue . Al l experienced operators agree in the adv isability ofincluding the peritoneum within thesti tch , as i t is found when the two edges are thusbrough t together they unite quickly by first inten

tion and this i s desiderated in order that if sup‘

puration take place outside, pus and other septic

fluid may be prevented entering the peritoneal

The wound should then be covered with drylint, or l int soaked in carboliz ed oil over this and

the whole abdomen should be placed a th ick padofdry cotton-wool , and several folded napkins,while broad strips ofadhesive plaster should bepas sed nearly around the body, to support the ahdomen in case ofvomiting. Lastly a wide flannelb andage should secure the whole. The patient

sh ould now be placed in a comfortable bed , between blankets

,and warmth for a time , even in

hot weather,should be appl ied to her feet. The

room is then darkened and th e patien t left qu ietly

alone with her nurse.

THE AFTER-TR EATMENT.

As this i s a matter of the greatest importance,

the operator must, himsel f, give particular attention

to the minutes t de tails of the after-treatment. He

should secure the assistance ofa medical friend tosupervise th e case in h is temporary absence

,and a

competent nurse must be in constan t attendance

night and day. The patient must be kept quiet,

at rest,and free from pain . To accompl ish th is

,

an opiate should be admin istered hypodermically,or per rectum . To prevent vomit ing a l i ttle

"

i ce

may be allowed, but no. food or drink . I f the

powers ofl ife seem to be flagging a l i ttle brandyand iced water must be given by the mouth

,or an

enema ofmilk and brandy. The room must bekept comfortably warm , at an even temperature,but wel l ventilated. This can be eas ily effected bya l ittle fire in the grate— th e best ofal l venti latorsfor a sick room ,

— or a gas j et can be kept burn ingin the fire place . The bladder . must be empt iedby a catheter every six or eight hours the bowelsshould be kept constipated seven or eigh t days

,

but in case the intestines become distended withgas

,they may be unloaded by a simple enema of

warm water, as early as the fifth day.

Should vomiting persis t after the effects oftheanaesthet ic have passed away neither food not

drink should be allowed by the mou th,—absolu t ’ely

noth ing, excepting ice to suck, and perhaps a desertspoonful ofl ime-water and milk , in equal parts,at stated interval s. Life must be ‘

sustained by

rectal al imentation .

* Enemata ofnutrit ive material s already preparedfor assimilat ion , as beef-essence

,beef-tea, mutton , oyster or chicken-broth ,

or egg beaten in m ilk,~may be administered every

o o o'

*That l ife can be sustai ned W i th nutri ti ve i nj ecti ons, 1?tthe rectum, i s proven in cases 4 and 5 ofthe appendix.

i s on ly within the pastfew years that the importance ofthi sm eans ofsustain ing nutrition has been recogn ized by theprofession . Oflate, recourse is m orefrequently had to thi smethod ofnourishing the patient, not on ly in persistentvom iting after ovariotomy, but also in the various d iseasesin whichfood cannot be swal lowed , nor digested by thestomach ; and recently cases .have been reported in whi chlife had been sustained , by this means , d uring period s varyingfrom three months , to three, and even five years. Thequestion remains to be determ ined : whether the nutriti velmaterial, thus adm in istered , i s d igested , or merely absorbed.

THE CANADA LANCET.

three or four hours,i n quantit ies ofabout fo ur

ounce sat a time. Brandy and medicines, when

necessary,may be added to the inj ections. The

nutritive material should be s trained and warmed

previous to being administered,after which

,the

anus must be supported for a time by firm pres

sure with a napkin . After three or four days, when

al l tendency to vomiting has ceased, or as soon as

the stomach begins to crave food , small quantitiesof l ight nourishmen t may be tried

,A spoonful of

milk,beefa tea

,or oyster broth , may be given at

frequent intervals,and if such nutriment agree with

the stomach,other articl es of similar diet , and

small portions of sol id food can be permitted. a

I f_th e patient appear to be doing well , as indi

cated by the general symptoms— pulse, temperature,respiration

,and freedom from pain— th e wound

need not -be examined until th e th ird or fourth day,when it should be cleansed and dressed with freshmaterial s . Should suppurat ion be then comm en

cing in any part ofthe wound, or aroun d the pedicle

,th is must be carefully sponged twice or thrice

a day,after which

,the wound i s each time dressed

w i th l int soaked with carbol ic oil. The upper partofthe incision usually unites immediately by fi rst

intention , and the whole wound infour or five

days ; but the sutures are not removed until the

seventh or eighth, unless some of them become a

source of i rri tation . When the clamp has b een

employed, i t i s left undisturbed until i t become

loose and ready to be removed withou t any trac

tion the time varies with the thickness of the ped

iele, but i t usually fall s offabout the eigh th day.After the su tures and clamp have been removed ,

the abdomen must be supported by adhes ive plas

ter,pads ofcotton wool and an abd ominal band

age. Even when the patien t leavesfor home, sheshould be enjoined to continue the support by theelastic bandage

,corsets or some other abdominal

supporter. HEMORRHAGE.SHOC K;

Occasionally,however, ovariotomy cases do not

get on so favorably as above indicated . I t not

unfrequently happens that the nervous prostration

we are

‘

accustom ed to S peak ofas exhaustion ,shock

,or collapse

,continues after the u sual

'

t ime

expected from the effects ofanaesthesia and theoperation . The patient does not rally, but gradu

al ly s inks i n spite ofour b est endeavours to re

v ive her fail ing powers. With this depression of

the v ital forces most of u s are famil iar,as occur

ring after capital surgical operations,and railway

and other,severe accidents. In reference to th is

condi tion,Dr. Barnes makes the following original

and pertinent observations : A considerable

s“ proportion ofall th e deaths

,I am convinced ,

occurs from s/zoc/é. R ecovery from this is greatlya question of individual power ofendurance .We can hardly foretel l what this power is in anyparticular case . Women recover from the sev

“erest operations attended by al l the complica

“ tions considered the most form idable others“ sink after the easiest and simplest operation s .Women comparatively robust

,succumb

,wh ilst

the apparently fragile recover. In many casesthe unexpected result is not due, at l east appreciably, to difference in skill .

I t can only be referred to difference in innatepower ofresistance. This is an unknown quan

“ tity,and is the chief cause of th e uncertainty

which surrounds the operation . No doubt the

shock can be lessened by care and skil l duringthe operation

,and the patient can be to some

extent supported through it .”

Vigilant supervision and good managemen t bythe operator

,personally, at this cri tical time, may

succeed in reviving the sinking powers. Warmth ,even in hot weather

,must be kep t constantly to

the feet,legs

,ax il lae and card iac region . When

th e stomach will retain s timulants, iced brandy or

iced champagn e,can be given by the month. But,

when obstinate vomiting persists , ‘the stimulants

must be administered per rectum ; and ifmeces~sary

,ammonia hypodermically. The patient must

be kept quiet on her back, and free from pain bymorph ine subcutaneously

,or laudanum added to

i

the enemata . In other desperate cases, when the

patient does not sink from exhaustion , we scarcely

expect she wil l survive the secondary dangers ofhemorrhage

,periton i t i s and septicaemia.

Should internal hemorrhage occur, indicated byprogressive faintness

,and a feeble, frequent pul se,

the wound must be re-opened, the bleeding vessel

secured,and the peritoneal cavity again cleansed

This appears a desperate undertak ing, but the condition is an extreme on e

,as the patien t, if left

alone,will bleed to death . The above procedure

otfers the only hope of arresting the hemorrhage.During all this t ime, the operator must be on the

constant watchfor symptoms of

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THE CANADA LANCET.

.Dry cold appl ied to the head, however, bymeans ofth e ice-cap, or th e coiled tubing conveying .i cedwater— as first practiced in Glasgow forinjuries to the head, employed by Mr. T horntonto.r educe febrile temperature following ovariotomy,and approved by Mr. Wells— I d oubt not, will

p rove useful for that obj ect, as I have observed

i ts t iben eficial efl'

ects for inj uries Ofthe head in the,H amilton Hospital. O thers have recourse to theu se ofthe ice-collar to the neck , the ice-bag to thespin e , or the icedbath for the same purpose, and

with astonish ing results.

S EPTIC tEM IA.

{L‘

he exist ing periton itis , if not speedily checked,especially if the inflammation has been set up by

decomposit ion and septic absorp tion , will quickly

,develop or resul t in that more formidable condi

t ion —septicaemia. Not unfrequently the two arecombined, or run concurrently, at l east i t i s im

p ossible to define where the one ends and the

tether 'begins. Some assert that sep ticaemia may‘pccur wi thout any previous or perceptible peri ton

fi ti s. Usual ly,however, septicaemia is the result of

p eriton itis, which has been started by _

septic ah

Sorption. The symptoms by which i t is, ushered

i n a re well portrayed in the quotat ion from

ll‘

homas’

s work concerning th is condition,and the

;usegoft he drainageftube. The top ical treatment‘

Qfthe peri toneal cavity by means ofant iseptic injections through the drainage-tube

,must be

{ fisorted : to, and in case the tube has not

been employed, the cavity must be boldly tapped ,allaturbid serum

'

withdrawn , and then thoroughly

(finali sed by antiseptic inj ections,through the

canula.

”

C ONC LUS ION .

‘

I iIm conclus ion, permit me to say that ovariotomy

i s an konerous undertaking. The .

’

conscientious

surgeonfi nds, from the moment he takes the casei n diandp that in addition to the a nxiety he mustfeel , ri t make s a ;demand upon his time, thoughtnew e tand iski ll, for which no merely financial t e

m uneration can ,possibly recoup him. I t is the

convictinn rofthe wr iter ,that no practit ioner shou ld

hnd eflakefihis iform idable operation , who has not

M d tconsi ide rablee xperie'

nce as a surgeon,and who

( .To be con tinued.)

PR ACTICAL OBSER VATIONS ON THE

TR EATMENT OF DIPHTHER IA ANDDIPHTHER ITIC CR OUP.

BY A. H. C HANDLER , M.D .,DORC HESTER, N.B.

The rapid dissemination ofdiph theria in townand country

,and the frightful mortal ity in many

local ities,have induced me to offer thefollowing

Ob servations on the treatment ofthis dread disease.I t is with some d iffidence the subject is approached ,after th e exhaustive manner in which the principlesoftreatment are laid down in the last issue oftheLANC ET. There were some points, however,scarcely touched

,upon which,i n this paper, I de

s ire espe cially to dwell . In the articl e (Feb . LAN

C R T)“ Prognosis and Treatment ofDiphtheria

,

”

Dr. Lewis Smith observes,“ There is -no known

antidote for diph theria,in the sense in which

quinine is an ant idoteformalarial disease." Fromso h igh an authority, l et me venture to differ;andto assert that alcohol in th e form ofwhiskey or

brandy,given in large and frequently repeated

doses,at the very onset ofthe disease, i s not only

antidotal,but abortive and curative as well , in the

more advanced stages,in all save a smal l minority

ofcases.Like quinine in some few cases ofague, i t may

occasionally fail,but th e exceptions are rare in

adults,and in children from abou t seven years of

age upward. Very young ch ildren , however, ihcluding

,Of course

,infants

,and those affected with

diphtheritic croup, cannot bear alcohol in rapidly

repeated,and comparatively large doses ;

'

but those

ofmore mature years, with adults ofall ages, can

take i tfreely from the first inception ofth e maladyhas not ia -pene/zant rfor , 81ich pract ice ; who cannot without i ts producing th e usual in ebriant effect.trans fer -his patients with .contagious diseases to The former wil l bear one half-ounce every houranother ; and surround himself' with skillful and or two hours

,the latter from two to fou r ounces,

cool-headed assis tan ts ; and 'who will not devote

h imself almost exclusively to the after-treatment ;for, unquestionably, i t i s by stri ct attention to the

preparation , and the total ity ofth e l ittl e circumstances connected with th e operation

,as well as

,

and more particular ly, the after-treatment, that

success so much more frequen tly is now the resul tof the operation .

THE CANADA LANCET.

according ti) th e rapidity and malign ity ofthedisease. Should th e attack not abort in twenty.

four hours, the continuance ofth e stimulan t wil lalmos t i nvariably hasten the exfol iat ion, so tospeak , ofthe fal se membrane, in two or three daysat

.

most.

The only additional treatmen t, excluded however in cases seen early, i s sulphur blown into ‘

th e

throat every two hours , freely and continuously,whil e a trace offal se' membran e forms or spreadsalong wi th iced ch lorate ofpotash as a drink aa

’

In cas es seen ‘

later, quinine, or i ron and

quin ine, are sometimes essential, with stimulants, ac

cording to degree of debil i ty. In adults, when glan

dular engorgement is great,threatening even

laryngeal obstruction from pressure inwards , ice, in

bladders appl ied at nigh t, the critical t ime, is of verygreat service.

I t is,however, with the treatment ofdiph th eritic

croup Io

wish more part icularly to deal. In th is

form ofthe di sease,prostration at first

,at al l events

i s comparatively rare,with but l ittl e extension 0

membrane abou t the ton sil s and uvu la. Indeed,

the l i ttl e sufferers often run about daily,with

s carcely a febrile flush , appeti te as usual, vi vaciou s

too, playful and happy but alas how flatteringlydecepti ve. At midnight, perhaps , or approachingearly dawn , the ch ild awakens wi th more or l ess

croupy cough,which

,wi th the usual domestic aids

passes offby breakfast t ime. Slowly, bu t surely

and steal thily,however, a fal se membrane has

formed,and n igh t by nigh t the croupy cough ings

increase, gradually developing in to th e day hours .On looking

,now

,at th e throat, th e tonsil s will befound engorged and purple

,wi th l i ttl e circular

patches here and there ; or i t may be, a singles t rip offalse membrane, and unless soon rel ieved,death is presently

,the inevitable result.

In other cases, the' membranous laryngi t is is

very acute and sp eedy in progress from the fi rst,

w i th great engorgement ofgland and cellular t issuewi thout , as wel l as tonsil lar swel ling with in ; andthe patien t chokes up in a very few hours

,either

‘ In rebe llious ch ildren , i nfan ts, or in any case wheremembrane threatens to spread rapid ly, thefollow ing '

appli ed

by means ofap liable and firmfeather tip , every two hours ,d iluted with equal parts ofwater,for young children , wi llalways befound u seful.

R . AcidTinct.G l

'

ycerinae

from pure mechanical obstr uction , or the latter

conjoined with acute congestion ofthe lungs, or

i t may be,capillary bronch i ti s.

In all croupy cases,i t is essential to begin with

the free appl ication of heat in some form aroundthe throat and n eck

,either i n the shape ofpoul

tices, or folds ofl in t wrung out ofvinegar and hotwater, covered with thick flannel

,and frequently

repeated , n igh t and day - the grand obj ect to be

kept in view being the continuous appl ication ofheat and moisture. As croupy symptoms develop,apply a fly bl is ter across the front ofthe ches t,and ihsevere cases, the back of the neck as well, or

even on the thighs or l egs. In ch ildren , however,young, keep the bl ister Open , until out of danger

,with any form ofstimulating application or

oin tment. As such cases always h ear depress ing

treatmen t, full doses of alum or a n timony may be

givenfor afew hours,followed up rapidly with

diuretics,and if not decidedly rel ieved , the iodi de

and bromide ofpotas sium in frequently rep eat eddoses, along with the chlorate. Diet : milk and

chicken broth liberal ly. As the graver symptom sdecl ine, under the above measures , extreme weakness s ets in

,sometimes speed i ly, which is e as ily

met with qu in ine and wine,accord ing to the d e

gree ofprostration .

It may be here stated, an in teres tingfeature willoften be not iceable with regard to the coun ter-i rritan t; from the second or th ird day ofappli cation .

The bl istered surface in stead ofd ischarging or

d inary pus, will often now be found to assume theprecise appearance ofdiphtherit ic fal se membrane ,as indeed i t is

,flaking off, as in the throat, whil e

convalescence advances . The following i s a case,the gravest ofthree, recently treated (all diphtheri t ic) that conval esced last week .

CAS E 1 . Albert W. aet 5 .—Feb. 7 t/z, 1 878 . Was

called in , early in the morn ing ; child had be en sick

during the n igh t ; great glandular engorgemen t ;very uneasy a smal l patch ofdiphtheri ti c mem

brane on righ t ton si l face in tenselyflushed 3anxi ou s countenance skin gen erally hot, and complains much of. headache ; mout h and breathfoul.Treatmen t ; hot app l ica tions to th e throat, renewedfrequen tly, antim ony and alum in ful l doses everytwo hours until he vomits freely afterwards everyfour hours.Feb. 8tlz.— C h ild much rel ieved ; sti l l cons iderably croupy however, butfe ver and headache less.B l ister applied over sternum , x

THE . CANADA LANGET.Feb. 9th— Stil l easier ; to have milk and broth

l iberally,and frequent doses ofchlorate ofpot

ash . Sen t for in the middle ofthe night had beengrowing worse since ev ening ; great dyspnoea

high fever and flushed cheeks. Found on examination

,intense congestion ofboth lungs

,pulse 145 .

A strong mustard plas ter was applied over theblistered surface

,mustard cataplasms to the back

,

and to have the following every two hours,in twoteaspoonful doses .*

R . Ant : Tart. gr. i .Tr. Colchici .Digital

,aa 3

Syr. Scillae.

S pts Eth : nit dd 3 i ii .Syr. Aurantii 3 i .Pot Chlor. grs. xx.

Aquae ad. 3 iv.— M.

‘Feb 1 0th — Much be tter ; dyspnoea subsided ,

cough loose ; blister Shew ing a closely-adherentfalse membrane ; breath Stil l offensive ; small patchof false membrane yet cl inging to tonsil. Sulphur

to be blown into the throat frequently. To cont inne medicine every three hours

, i ncluding a sen

ega and ammonia carb. mixture,every two hours.

‘Feb. [ I fit — Much better,but quite weak ; pulse

95, feeble and compress ible. To have strong

broth and qu inin e every hour in full doses,but

wi thout stimulants . On examining the bl ister,the

adherent cloth dragged up one com er ofthe falsemembrane which bled considerably the ‘ whole

blistered surface , being one th ick yellowish whitediptheri tic membran e, which separated piece-mealfrom day to day, under a weak carbol iz ed dressingofacid and ol ive oil.Feb. 1 3 th

— Child much stronger ; improving

rap idly, with keen appetite still some cough. To

have a mixture ofcherry bark,hypophosphites

,and

cod-l iver oi l emulsion .

In regard to the treatment ofadults,

'

tli e following are two recent typical cases

I . W. father ofthe ab ove — R b. 15 th— Was

seiz ed during the nigh t with pain and swell ing intht hroat ; high fever ; headache and boundingpulse ; face much flushed ;feels ‘ weak

,and wants

to lie d0wn . I t may here be stated that the

father had been nursing the littl e child,who

“Th i s comb i nation , w ithout the antimony in the early stagesis highly efficien t in the case ofinfants , and very youngchi ldren , labouring under acute congestions anywh ere, actingsometimes on the skin , and sometimes on the kidneys .

was constantly in h is arms, all through h is illness.

Tonsils on examinat ion much swollen , dusky red ,and covered with false membrane. O rdered

brandy, two ounces every h our, n igh t and day no

other treatment.Feb. 1 6th — r 1 A.M.— Swell ing in tonsils sub

sided better in every way. To leave offstimulan ts to-day, and drink freely ofbeef-tea. Falsemembrane separating.Feb. I 7 t/z.

— A l ittle weak to remain in th ehousefor a couple ofdays. No further treatment.

CASE 3.— Charlot t e P . aet. 1 3 . Throat had been

sore for the past two days, but she said noth ing about

i t. On visiting, found her recumbent, with headache

,pain in the back , and high fever. Had been

del irious during the past n ight ; pulse over 1 00 ;

false membranes on both tonsils and completely eu

velop ing uvula, which latter was greatly swollen

and oedematous.. To have an ounce ofbrandyevery two .hours

,and sulphur blown into the throat,

with iced chlorate ofpotash freely as a drink dayand night.Feb. [ gm- No decided change for th e bettervery weak glands of the neck rather more swollen .

Continued stimulants freely,from sixteen to twenty

ounces in the twenty-four hours .Feb. 20t/z.— Patient decidedly better, and false

membrane rapidly separating. From this date thestimulant was gradually withdrawn, patient makinga speedy convalescence .

The above illustrate a,

number ofS imilar cas es ,that have occurred during the last three months

,

and that have been successfully treated under the

above plan . With regard to the sudden failure ofthe heart ’s action often observable even after con

valesc ence i s fairly establ ished, le t me enjoin the

immediate and free use ofalcohol ic stimulants,

which may be given with the freedom of water, aslong .as the tendency to syncope las ts, without

danger,and with the certainty ofsuccess. In these

cases ofgreat glandular engorgement in adults,before referred to

,l et me repeat th e advan tage to

be derived from the continuous app l ication , by

night, ofbladders ofice.Aword or two, in regard

-to the much vauntedchlorine m ixture.

’

I t must be the experience ofmanywho have used this preparati on among children

that wh ile agreeing well with adults— ih very young

children i t has caused so much irritabil ity of the

s tomach, that i t has tobe abandoned altogether .

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THE C ANADA LANCET.

The above was,certainly a bad case, and shews

how continued,patient

,and persevering effort, i s

sometimes rewarded with success,when least ex

p ected . The little sufferer hadfortunately a goodstomach

,taking every thing offered , amid her

breath-s truggles,with great energy and pluck . On

the two days her l ife was despaired of, th e mostenthusiastic tracheotomist would hardly have even

li azarded an operation . I t i s perhaps unnecessary

to add, in all cases ofdiph theria occurring infamilies

,that the unaffected S hould be rigidly quar

antined in a separate apartment ofthe house , whenever practicable. Every room should be disinfected

d aily, or twice a day with sulphur or chlorine fumes .

During convalescence ,ton ics should be admin isteredwi th nourish ing broths, e tc. the convalescent too,should be housed

,especially in the winter season

,

for some l ittle t ime,and cold draughts avoided

wi th the same wariness,as after attacks ofmeasles

o r scarlet fever.

These observations are humbly submitted to my

medical brethren as the result offifteen years ex

p eri ence in the treatment ofdiphtheria. Many ofthe principles here advocated

,are ofcourse

,not

at all n ew, but have been long recogn iz ed by lead

i ng practit ioners throughout the Domin ion and theUnited States .Dorchester, N.B.

,March 1 2th, 1 878.

NOTES ON PUER PER AL CONVU LS IONS.

BY E . G. K IDD,M . D.

,MANOTIC K

,ONT.

I am well aware that the following cases present

nothing new, either in the pathology or treatment ofpuerperal convulsions, yet as the disease i s comparat ively rare, and must always be ofin terest to us, Ibeg to offer them as my share ofexperience.

. CAS E 1 .-Mrs . H . aet 2 7 primipara. Labour

commenced in the even ing of 1 6th ofMay, 18 7 1 .

I saw her about 9 o’clock that nigh t th e l imbs and

face very oedematous,the oedema having coni

m enced about the end ofthe S ixth month . Urine

albuminous she had an anaemic and waxy appear

ance. During the last two months She has had in .

tense headache. Labour was slow,and completed

by th e forceps. About an hour after delivery she

complained ofbl indness,and in a few minutes

convulsions came on ; during that nigh t and n extd ay she had e igh t convulsions. Owing to the “ age

G

and experience Ofth e gentlemen in consul tationwith me

,there was no treatment until She had had

four convulsions. I then tried to bleed her, butcould not find a vein in her arm owing to theoedema ;administered chloroform ,

gave a full dose ofcalomel and jalap , followed by pulv. jalap. co.

,I ce

to the head, a hot air bath, and d i luents aa’ tz'bz'tum .

She made a good recovery,became pregnant again

in 1 8 74, and about the sixth month , oedema , album inuria

, and headache returned. I ordered pulv.jalap . co . and diluents . She wen t to ful l time andhad an easy labour

,no complications.

CAS E 2 .— Mrs . R . multipara was attended by

a midwife through a severe and tedious labour,

j an . 7 th, 1 8 74. About an hour after delivery convulsion s came on . I was sent for

,and saw her

about an hoU r after the first convulsion she had

had three during that time I found her plethoric,

oedematous, urine albuminous. The pulse wasful land the breath ing stertorous

,face l ivid I bled her

immediately, and she gradually became conscious ,as the blood flowed from her arm appl ied an icebag to her head, and as soon as sh e was able toswallow, gave her a full dose ofcalomel and jalap,followed by pot. bromide , diluents, etc. There were

no convulsions after the bleed ing made a good t ecovery.

CAS E 3 .— Mrs . W ., aet 30 multipara consulted

me in March , 1 8 74, for dropsy. Was in n inthmonth of second pregnancy anasarca was general

urine albuminous . Gave pulv. jalapae, and mild

diuretics, and told her husband to send for me assoon as labour se t in

, or before, if convulsionscame on . Convulsions came on three days after my

firs t see ing her ; labour had not commenced ; Iadministered chloroform , and gave pot. brom ide infull doses in a few hours labour commenced

,and con

vulsions ceased. When the 03 was dilated to aboutthe s iz e ofa penny, she had a convulsion , and in afew seconds a dead child was born . She pro

gressed favourably until the th ird day,when having

eaten rather freely,the convulsions returned with

great violence and frequency. I bled her freely

gave chloroform when I expected the convulsions ,and a purgative . To continue the pot. bromide .S he made a good recovery. During the th ree days

interval between the birth ofthe child , and thesecond onset of the convulsions

,the oedema an d

albumen decreased both increased rapidly duringthe convuls ions.

THE CANADA LANCET.

es sfor eighteen hours.W. primpara; consulted mefor

dropsy in June 1 8 74 oedema marked ; urine scanty

and albuminous. I s now in oth month of preg

nancy has occasional at tacks ofheadache withvomiting and purging ; i s anaemic ; ordered mild

tonics and diuretics. Convuls ions came on duri ng

severe and tedious labour,about three weeks after

my first seeing her. Administered chloroform,

appl ied th e forceps,and del ivered as soon as pos

sibl e'

; she made a good recovery.

CAS E 6 .— Mrs . C. a stout plethoric primipara

was attended by a midwife in July 1 8 75 . C onvul

sions came on previous to th e birth ofchild I sawher shortly after onset. She was oedematou s urine

albuminous ch ild was born before my arrival— st il l

born . She'

has had occasional attacks ofvomit ingring the last three months. Bled

jalapae, diluents and pot. bromideafter the bleeding.

rim ipara oede

ing convuls ion s, I appl ied the forceps and del iveredas soon as poss ible. Before applying the forceps ,while in a pain she became unconscious. After

del ivery she rall ied ; but a convuls ion came on

abou t half an hour after,and she died . I could

not bleed, her arm was so much swol len in fact,She died so quickly that I had no time to do any

thing ; as soon as the spasms were over sh e was

dead . I have attended two cases besides those

given been,but have no notes ofthem ; both

recovered.

NEUR OMATA OF THE STUMP AFTERAMP U TATION OF THE AR M.

BY JAS . M. SM ITH, M .D.,MORPETH

, ONT.

Mr. T a well to do middle-aged farm er,had his r ight arm crushed in a threshing machin e,on th e 1 9th August, 1 876. Being sentfor immed iately

,I found

, on arrival at th e place, th e

inj ury ofso seri ous a nature as to require ampu

tation , and assi sted by Dr. R ichardson , ofChathamI took the arm offat the upper th ird . The stump

healed kindly,and th e case progressed so favor

ably that in four weeks from the day ofth e acci ‘dent

,h e drill ed in five acres ofwheat.For a long

time he complained of no trouble or d isturbance,other than i s common to such cases .

On the 22nd ofOctober, 1 8 7 7 , h e called at

my offi ce,much emaciated , and complaining of

extreme sensi tiveness and constant pain in an d

about the stump,attended with muscular weakness,

tetan ic movements ofthe muscles ofth e parts ,stiffness of th e muscles ofth e neck and jaw, d ifficul t deglutition

,and general derangemen t ofth e

heal th . On examining the stump , I found severaltumors ofvariou s S iz es, th e largest at the term ination ofth e median nerve, and o thers in the n eighborhood ofthe brachial artery. Sligh t pressur e being

appl ied to these bulbous enlargements, increasedthe tetanic movements

,and produced most excru

ciating pain .

The opin ion had been volunteered by some, thatthe median nerve had been incorporated in theoriginal cicatrix. Indeed I should have incl in edsomewhat to this view myself, had I not taken es

pecial care to avoid such a calamity at the time'

ofamputation . Having tried pal l iat ives to no pur o

268

pose,I advised the use ofthe knife, but requested

h im first to con sult Dr. Murphy, of Chatham , who

advised the removal ofthe tumors as the only suremeans ofgiving permanent rel ief. A few days

afterwards,the patient was brought under th e in

fluence ofch loroform,and Esmarch ’s bandage ap

pl ied from the point ofth e stump to th e top ofthe Shoulder. An incision being made three

inches long, close and nearly parallel to the origi ~

nal cicatrix,and over the median nerve, I came

down upon the first tumor, which was removed at

once. Tracing up th e incis ion , I came upon

another of smal ler siz e,about an inch from the

first,which we removed in l ike manner. The tu

mors were bulbous enlargements, having a firm ,

dense consistence,and constituted a diseased,

hypertroph ied degeneration ofthe nerves, that ofthe median being three inches in length and two

inches in diameter. In th is case,the nerves were

entire ly free from the old cicatrix.

Where the tumors were multipl e,as in this case,

amputation was formerly resorted to for rel ief.

Why degeneration ofth e nerves takes place afteramputation of the arm

,more frequently than ofany

other part is,in my opinion , owing to the way the

secti on is made in performing the flap operation,as was necessary in th is case . Unless the median

nerve bewell retrenched , S im ilar results mayfrequently occur. Of course th is condition of thenerves takes place

,more or less

,after all amputa

tions,but only demand surgical interference

,when

extreme,as in the foregoing case. During the

Operation,not more than a table-spoonful of blood

was lost . The distressing symptoms have entirely

disappeared,and the pat ient is n ow able to S l eep

and work as usual . Dr. Murphy kindly and ably

assisted me in th e operati on .

5 21mm guinea.

FR ACTUR ES OF THE NECK OF THEFEMU R IN THE ADULT.

C LIN IC BY FRANK H . HAM ILTON,M .D.

as a >l<

We will now considerfr actures oftbe neck oftirefemur,ofwh ich we have several examples before

us. I shal l confine myself to these fractures asthey occur in adul t l ife. Fractures ofthe neck inearly l ife are exceedingly rare, and the few cases

THE CANADA LANCET.

which have been recogniz ed cl inically have all lefta doubt as to their exact character.I do not propose

,to Speak particularly of the

pathology of these accidents, or of their causes or

S igns. I Shal l assume that you have studied allthese matters. My present purpose is to speakonly ofthe tre atment.I t is necessary to say

,however, that a fracture

may occur with in th e capsule or without the capsule

,and that the latter are almost always impacted,

th e neck being driven into the shaft, and beingthere more or l ess firmly fixed. We have thesetwo kinds offractures in old people mostly

,and

although the differ considerably as to their causes,their symptoms and their resul ts, the proper treatment in the two cases differs very l ittle .Let u s see. I f the fracture is with in the capsule

,

i t may not shorten at all at first but inasmuch asin almost every such case

,perhaps in every case

,

the neck will be in part or in whol e absorbed , generally within a few days or weeks— for th is processofabsorp tion goes on very rapidly after the fracture has occurred

,as I have proven by several

operations upon the cadaver,— for this reason a

shorten ing must soon occur,and in the end the

upper end ofthe shaft will become attached byfibrous tissue, perhaps to the head ofth e bone, t emaining in the socket

,perhaps to the capsule and

other parts about the j oint- perhaps to both andthe shortening is apt to be very great, being probably greater in proport ion as the upper end ofthe shaft and the portion ofthe neck attached toit is drawn farther from the head by the action ofthe great muscles ofthe th igh and hip. You see

,

therefore,that in this case it might be an obj ect to

hold the l imb extendedfor a t ime with a weightand pulley, and thus to make the fibrous bond asshort as possible ; in oth er words, to secure forthe l imb as much length as possible. I do notspeak ofth is as an ascertained fact

,namely, that

by permanen t extension maintained for a fewweeks, the l imb, in case

‘

i t has been broken withinthe capsule

,will be in the end longer than if no

such extension had been used. I t is a theoryonly

,which to me seems plau sible, but which I

have not proven. If,as some have thought, and

perhaps some stil l th ink,a bony union is Occasion

ally effected after this fracture,

then certain ly the extension would be useful for this purpose. I do not deny that such a thing has everoccurred

,but I have never seen i t

,and I think its

occurrence very improbable,even under the very

unusual and most favorable circumstance, namely,when the intracapsular fracture is at the same timean impacted fracture. I do not discuss that now.

All I wish to say is,that my treatment would be

proper in any v iew ofthe case.

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THE CANADA LANCET.,

than the other,and that h is tailor always made th is

difference in the length of his pants . There beingno eversion or other sign offracture, I directedthat no apparatus should be appl ied

,but that the

l imb should be measured from time to time,and

that he should be kept in bed. O n the roth daywe found half an inch additional shortening

,in al l

one and a quarter inches,and as this determined

the question offracture, extension was at once appl ied. The resul t is that we have prevented anyfurther shortening. The l imb being now on e anda quarter inches shorter than the other

, or one-halfinch shorter than natural. There is n ow the characteris tic enlargement about the trochanter

,show

ing that it i s an extracapsular fractu re.I cannot say positively that this l imb was not

some shortened at firs t,as I have nothing but h is

statements to rely upon but i t certainly shortenedafter he was admitted

,and this is a new and im

portant poin t. I bel ieve,from my later experience

,

that th i s happens pretty often when extens ion isnot employed.

My fourth case is ofunusual interest,because

the same fracture has occurred in both th ighs atdifferent periods oft ime

,and the treatment and

the results have been different . In all,I am able

to presen t you then with five cases of extracapsularfracture. This last case i s as followsDennis Kelly, then seventy-two years old , was

admitted to Bellevue in November,1 8 7 3 , with an

extracapsular fracture of the left leg. On theninth or tenth day after admission

,and after frac

ture, the l imb was done up in plaster-of-paris MEANSFO R PR EVENTING ATTACKS OFbandages, and soon after h e walked about. The EPILEPSY— EPILEPTIC AUR A— IMPORplaster remained ou several weeks

,being once re TANCE OF ITS AR R EST.

newed.

On the 30th ofOctober last he fel l upon therigh t side, breaking the neck ofthe femur on ther ight side, outside of the capsule, and was admitted at once to th is hospital . On the following day

,

Dr. Halsted appl ied my dressings,with eight

pounds ofextension . The man says Fromthe moment the extension was appl ied I had nopain .

” This is th e usual testimony. The apparatus was continued about five weeks

,and we have

now to note the results of the twofractures . Theleft leg— treated with plaster-of—paris— is hal f aninch shorter than the righ t— treated by ex tension .

The left trochanter and upper part ofth e leftfemur is bowed out, causing an ugly proj ection ;th e right trochanter and shaft have their naturalposition . In short

,the left l imb is in the same

situation it would have been if nothing had beendone

,perhaps worse. In the right leg the resul t

i s certainly better. I am going to have the patientphotographed.

In trampsularFracture. —F inally, I wish to shewyou

,gentlemen

,th is old lady, Catherine Daly.

She says she is seventy years old . This is an intracapsular fracture the only intracapsular fracture

LEC TURE BY DR . BROWN S EQUARD.

ou t ofsix fractures of the neck which I have shewnyou to—day. In my Treatise on Fractures

,fifth

edi tion,I have spoken ofthe relative frequency of

in tra and extra-capsular fractures as still in dispute. In my experience, however, the extracapsular have been made the most frequent.Observe now the points ofd ifference. This

patient is the oldest ofthem all, but none areyounger than forty. The accident occurr ed, notfrom a fal l on the trochanter, but from a slip ofher foot whil e trying to drive flies from the room ;there is no enlargement abou t the trochanter, although three or four months have elapsed since theaccident ; and this is more than in either oftheother cases the toes are turned out strongly.

During th e first three weeks she was under thecare of Dr. Mott, and extension was employed bymy apparatus with eigh t pounds. Since then shehas been encouraged to get up and use hercru tches

,which she n ow does to some extent

daily. While the extension was on she was verycomfortable

,bu t a long confinement would have

made her bed-ridden,and i t was removed as soon

as the stage ofinflammation was passed.

This completes my analysis ofthese cases. Theresult is in no case perfect, but we have reason tobel ieve that all ofthose have been benefitted , andtheir l imbs rendered more useful , in whom moderate and continued extension has been employedfora period offrom three to five weeks — Md . R ecord :

I pass now to another point. I said yesterdaythat there is very frequently an aura in disease ofthe brain causing convulsions. I t i s very important indeed to exam ine wi th reference to th is po int;for if you find an aur a

,i t wil l l ead to the use ofa

series ofmeans which may stop an attack ofepilepsy. I f an attack of epilepsy can be arres ted,we do more than simply arrest that attack ; forduring an attack of epilepsy, changes occur whichprepare the brain for future attacks ; so , if one at

tack can be arrested,you may perhaps stop a gen

eration of attacks. It is i mportant, therefore, toprevent an attack ofepilepsy. Now, with reference to the means ofpreventing these attacks .Means for preventing the occurence ofattacks ofepilepsy were resorted to cen turies and centuriesago. Galen insis ted particularly upon the importance ofl igaturing the l imbs for th is purpose .Suppose

,for instance

,there is an aura starting from

the finger— a peculiar sensation or muscular spasm;Galen

,and a great many physicians s ince h is day,

and even in our own times, insisted upon th e

THE CANADA LANCET.

appl ication ofa l igature to the arm , with a view ofpreventing the passage ofsome influence from thee xtremity to th e brain. In real ity, we succeedvery frequently

,by the application ofa ligature ' to

the extremity, when th e aura is there , in arrestingan epileptic attack ; but it is not because we prevent something from going to the brain

,but i t is

because we send someth ing to the brain,and that

something is an irri tation already there,and which

if undisturbed,would produce the convuls ion . I t

is the same as that which occurs in diseases of th eS pinal cord , in which by taking hold ofth e big toe

,

you arres t completely,in most cases at least

, con

vuls ion s occuring in the lower limbs .For example,in cases ofspinal epilepsy

, the convuls ions maybe most violen t

,may last all day

,and may recur

upon the leas t touch of any part ofth e skin of thelower extremities in those cases i t is not rare atall , especially in certain forms ofth e disea se, thatdrawing upon the big toe brings about a relaxationofth e muscles and ends the convulsions . Anarres t of the morbid activity i n th e cells in thespinal cord is produced by irri tation of the nerveswhich go to the big toe

,and that arrest remains

sometimes for hours, and sometimesfor days butyou can reproduce the same phenomena in thesame patien t. Whenever the convuls ions exis t

,

you can witness the influence exerted by this irritation .

As soon as I was possessed ofthe idea that i twas through irritation exerted by the l igation

,that

an at tack ofepilepsy was cut short,I tried and

found that other irri tants appl ied to the skin produced th e same effect ;for example, such as extreme cold , great heat, pinching the part in short,any irritation of the nerves in the region wherethe aura commences may be suffi cien t to arrest anattack. In fact, th e patien ts themselves , if theyhave strength ofwil l sufficient

,when upon the

poin t ofhaving an epileptic seiz ure,can

,by mov

ing th e l imb rapidly, rotating the arm ,etc.

,perhaps

stop an attack. Any kind ofi rritat ion from theperiphery may act upon th e brain and arres t themorbid activity ofthe cell s

,and that i rritation can

su cceed even when appl ied upon the other s idewhere th e aura exists .As regards other forms

,if th e aura starts from

the s tomach , anyth ing wh ich irritates the stomachpowerfully, as a violent emetic , will save the patien tfrom an a ttack ofepilepsy. Certain other meansmay a lso succeed , as acting upon the bowels byan enema that wil l produce a rapid and considerable action ofthe muscles. Pressure u pon thebowels may bring about the same result

,if the

s ensation starts from that region . A galvanicshock , on the contrary, wil l produce an attack inmany cases . If the patien t has simply a vagues ensation of disturbance without any distinct placefrom which the aura arises , any means of producingi rri tation ofthe skin behind the ears

,or between

the shoulder-blades, may be of some service, suchas the appl ication ofi ce, a sharp blow from thehand , galvanic shock , etc. , Any medicine wh ichacts with great power either upon the stomach or

upon the bowels, or which acts with great powerupon the nervous system , may be of servi ce inthese cases .

MEDIC INAL AGENTFO R THE ARREST OFATTAC KSOFEPILEPSY.

A common remedy which is employed with somebenefit consists ofthree or four grains ofthe sesqu icarbonate ofammonia in a drachm or half-ounceoftincture ofcolumbo, or gen tian , or rhubarb ; i tis the alcohol ch iefly that acts . Taken withou tdilution

,i t is rather strong, and therefore a tri fl ing

quanti ty of water may be added . I t should becarried in the pocket

,so that i t can be used at

the shortest warning. R unning, j umping, anythingand everything that produces a change in thecirculation and respiration

,may be ofservicefor

the arres t ofan attack of epil epsy. You may notknow what means will operate bes t upon a patien tbu t

,recommending such means as have been

mentioned, he may try one after another un til h efinds that which succeeds best in h is individual cas e .In that manner

,you can perhaps

,save the patien t

from an attack.

C OMB INATION OFTHREE MED I C INES .

The combination ofthree medicines I havefound has considerable more power in controll ingepilepsy than the use of one alone or oftwo com

b in ed . I f you employ the bromide of potass ium,

you must employ with i t the bromide of ammoniumand the iodide of potass ium or ammonia. A com

bination ofthese three sal ts acts with far greaterpower than when either one is used alone. I t isessential always to add the bromide ofammoniumif the other bromides are employed . In thesecases i t is also essential to employ some means ofcounter-irritation at the base ofthe brain ; or, incases ofdistinc t aura, some means ofcounterirritation at the place where the aura starts . Inthose cases in which the aura s tarts in th e finger

,I

have succeeded most wonderful ly in controll ing th eattack by the appl ication ofa circular bl ister in theshape ofa l igature to the finger itself. There is

,

therefore,a series ofmeans wh ich can prove

succeessful in preventing attacks in these cases.As I said yesterday, if we can do so much in th eway of control l ing attacks of epilepsy , why shouldwe not be able to do the same against paralysis , asepilepsy and paralysis are in many respects al ikein their mode of production .

PARALYS I S AND C ONVULS IONS .Before speaking further of means oftreatmen t,

which may be ofimmense importance if modified

27 2 THE CANADA LANCET.

successfully, I wil l say a l i ttle more wi th referenceto the doctrine regarding the production Of paralys is and ep ilepsy, and also Ofwhat I have to substitute for the generally admitted theories .

. As you wel l know,the facts mentioned in these

l ectures seem to be quite in Opposition to theviews held by most physicians

,if not by al l. When

paralysis exis ts,for instance , in the righ t arm ,

‘ andwe find convulsions upon the righ t side ofth e braindestroyed, i t is adm itted that the centre ofth e w il lpower for the right arm has been destroyed, andthat is very natural

,therefore

,that the right arm

should be paralyz ed. In the same manner 1fweexcite the convolutions ofthe brain

, or any part ofthe voluntary motor apparatus— such

,for instance,

as arises from sl igh t inflammation at the surface Ofthe brain— and the patient i s attacked with convulsions

, i t is qu ite natural, according to the theorygenerally admitted, to look upon the irri tationthere as having p roduced such convulsive movements— as having put into play the motor activityOf the part where the disease exists. These twoi l lustrative instances— the paralysis on th e onehand , and on the other the convulsions— are ap

par en tly in perfect harmony with what i s supposedto be established . But

,as I have said many times,

we find the same th ing taking place,not only upon

the Opposite s ide,bu t upon the side corresponding

with the seat ofthe disease. Certainly the theorycannot apply in these cases . Besides

,we find th e

same th ing occurring when the d isease i s in partsofthe brain which are not able to produce theleast movements when irritated by galvan ism

,and

which we know,and we all agree

,do not belong to

the voluntary motor apparatrus. For instance ,disease in the posterior lobe ofthe brain

,according

to the theory admitted,should never produce par

alysis or convulsions but disease there often produces both convulsions and paralysis. We havethen something tak ing place, '

and occurring veryfrequently, wh ich i s the reverse Of what is generallyadmitted. What are the explanations given byphysicians and physiologists ofth e fact wh ich seemto be decidedly against their views ? The explanations, I must say, have been veryfew and verytimid and, indeed, I th ink that I have myself, infighting against the admitted theory

,put forward

these explanations very strongly. I believe thatwhat I shall now say can at least certainly explainsome Ofthese cas es . For instance

,in a case of

paralysis and convuls ions upon one side Of thebody, we make an autopsy and find disease in theposterior lobe of the brain upon the Opposite s ide .We know that disease exis ts at that point— we areabsolutely certain of i t but

,i t is said , what

evidence is there that there is no disease elsewhere ?There may be undetected disease in the part belonging to the volun tary motor apparatus

,when

the brain is examined,

in the l imited mannernecessary at an autopsy there may be disease in

some other part \ofthe brain which cannot be recogniz ed by the naked eye ; so we cannot becertain that disease does not exist

,unless further '

examination be made.There are many cases wh ich at once answer th is .

Obj ection . I f we find , for instance, that a patientis stricken with symptoms ofhemorrhage in thebrain he has al l those symptoms which are man ifested when hemorrhage in the brain occurs, andyet had no manifestation whatever ofbrain d isorderprevious to the attack

,which comes on suddenly.

Besides the symptoms belonging to hemorrhage inth e brain

,he has paralysis in the righ t arm

,con

vulsion s in the righ t arm and face, and he dieswithin a few hours

,as he may when the hemorrhage

is l imited . An autopsy i s made,and we find

hemorrhage has taken place into the posterior lobe .

Can we admi t that there was disease elsewhere ?What k ind Of disease could have been produced sorapidly ? What kind

.

ofdisease could have produced such paralysis as we find in the arm ,

occu ring j ust at the time the symptoms Of hemorrhageoccur ?I t is quite certain that in such we cannot say

that paralysis and convulsions,depended upon

something else than the disease we see. Whyshould not the same th ing be true when the paralysis and convulsions are upon the correspondingside of the body ? A great many cases besideshemorrhage will shew the same th ing. Embolismand softening may produce the same resul t. Forinstance

,embolism occurs

,and we have noth ing

except the fact that there is a plug in a blood-vessel ,and the congest ion and softening which surroundsthe part. If that lesion exists in a part which doesnot belong to the voluntary motor apparatus, wemust admit that the paralysis

,as wel l as the con

vuls ion s , is due to the disease seen, and not to thed isease imagined and which we do not see .O ther explanations and answers to these migh t

be given ; but as time presses, I will not indulge in .

them .

There is another source Of explanation wh ich isvery good indeed .For instance, in those cas es inwh ich d isease has destroyed the greater part Ofthevoluntary motor apparatus in the region where i t i slocated

,and there is neither paralysi s nor convu l

sions. How is the absence Of paralysis and con

vuls ions to be explained I t m ight be said— I donot say that i t has been said— that paralysis doesnot appear because only a part ofthe voluntarymotor apparatus has been destroyed. That maybe

,and that is the case sometimes when there is .

sl igh t disease ; bu t why is i t that their is neitherparalysis nor convulsions when a considerable partof the voluntary motor fibres are destroyedThen i t m igh t be sa id,

_

that though apparentlydiseased

,yet the tissue remained able to act. This .

explanation is certainly very good, and may be

true, but there is no proof Ofi ts tru th . In those

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THE CANADA LANCET.

s ist. But it is not so. I t must be that somethingexists which ceases to exist at the place where theeffect is produced.

We know that in animals we can arrest the activityOfthose cells wh ich serve for the production Of«s ight, and the act ivity ofcel ls serving to al l themental faculties and the wil l . The activi ty of thec ells employed in any ofth efunctions ofthe braincan be suddenly arres ted by certain irritation s. Incases, for instance, of hemorrhage into the upperpart ofthe spinal c01d, without possibl e pressureupon the brain , there may be immediate loss ofe onsciousness . There are two such cases upon record . Certainly there was loss ofactivi ty of all th efunctions of the brain as regards power Ofmotion

;and sensation , al l will-power, and that from anirritation which started at a distance from th e brain.

Certainly, also, there was no pressu1e upon thebrain in these cases . In these cases

,also

,con

i sciousness was restored after a time.Sometimes we produce death rapidly

,and de

s troy, therefore, all the activi ty of the brain , by am ere prick.

We can also produce a pers i stent amaurosi s by a‘mere prick of the r estiform bodies

,and the am

.auros is appears instantaneous . There is no directconnection between these bodies and the eye

,yet

; the amaurosis persists while the animal l ives andI have had an an imal that l ived more than two years

; after the production ofsuch a d isorder of vision .

All wil l-power and all sensibil ity also may be destroyed by a mere prick in certain parts. I f for ins tance, the spinal cord in animals be pricked in thedorsal region , i t i s found that sometimes there isproduced a cessation of the activity ofcells there

,

and we have anaesthesia upon the opposite sideand loss of w il l-power upon the corresponding side.We find in cases ofd isease of the brain that th e

pulse is weakened and is exceedingly irregulalong as the patien t l ives ; i t is an arrest Of theaction ofthe heart while the disease exists in the«brain . If the action Of the walls ofthe heart canbe so modified, and persis tently modified for monthsand months, the same th ing may existfor differentparts of the brain .

In the same manner,reflex activi ty may be

: arrestedfor months and months,as

,for instance

,

the cell activi ty which controls the contraction Ofthe sph incters ofth e bladder and rectum

,and the

loss ofcontrol over the action ofthese parts mayTh e permanent. The same th ing may take placefor the cells which control voluntary movements.

S rcxn ns s OFPREGNANC Y.— Dr. 1. Marion S ims

,

i n th e London Lancet,commends in the h ighest

t erms cauterization with nitrate ofs ilver Of the os.uteri for this trouble. He has found it most successful

, one to three applicat ions curing. Dr.ones, of Chicago, originated this treatment.

UNUNITED FR ACTUR E OF THE HUMBR US IN AN OLD MAN

,SUCCESSFULLY

TR EATED BY R ESECTION OF THE ENDSOF THE BONE AND THE APPLICATIONOFSILVER SUTUR ES.

BY MR . HENRY SM ITH,KING’S C OLLEGE HOS PITAL.

The value Of resecting the ends ofth e bones inununited fracture was very wel l illustrated in thefol lowing case. The patient was an Old man infeeble health , and therefore not a good subject forany serious Operative interference ; but, on theother hand

,with an ununited fracture of the hum

erus he was unable to follow his employment ofhairdresser. I t was th is last consideration thatchiefly influenced Mr. Smith in deciding to attemptreunion . The case was not immediately successful, but i t is not less interesting on that accoun t.as it shows th e importance ofthe element Of timein such cases. When the patien t was dischargedfrom the hospital

,four months after the operation

,

there was no s ign Ofosseous un ion , al though theends of the fragments had been kept immovableand in close apposition by means Of silver suturesand a splint. Two months later some callus couldbe fel t and one month later s till

, or seven month safter the operat ion , there was firm bony union .

Michael N aged sixty-one,a hairdresser, was

adm itted under the care ofthe late Sir W il l iamFergusson on march 6th , 18 76, with a fracture ofthe middle th ird Ofthe left humerus

,and a Colles’

fracture on the same side,which he had sustained

by falling down stairs.He was discharged on March a3rd , with the

Colles’ fracture u ni ted,but the humerus stil l unu

n i ted .

He remained in S t. G iles’s Workhouse ti ll Jan .

1 5 th , 1 8 7 7 , when he was admitted into the hospitalunder Mr. Henry Smith . The fracture at thejunction ofthe upper and middle th ird ofth e humerous was still ununited . He was in a very feeblecondition of health altogether

,and looked l ike a

man who had been badly nourished. The arm

was placed in splints,and

,as on March 1 7 th no

union had taken place,Mr. Smith performed the

following operation . A longitudinal incis ion oftwo inches was made down to the bone over theseat offracture the broken ends were then clearedand the fibrous tissue about the ends removed the .

broken ends were then sawn off,and a silver wire

passed through each end and twisted up , thusbringing the cut surfaces into apposition . The armwas put up on an angular inside splint.On June 26th th e fracture was still ununited, and

it was in the same condition on July roth, when hewas discharged with the wires left in.

O n Sept. 2sth he was readmitted. The wireswere s till in , and some callu s could be fel t aroundthem. On Oct. 4th , on removing the splint, union

THE CANADA LANCET.

ied .

sth the spl in t was discontinued the fraunited, and the heal th was fairly good ;a smal l depression in the skin at the si te

operation — I nc Lancet.

OPHTHALMIA NEONATO R U M .

In the LANC ET AND OBS ERVER for January, 1 8 76,I reported one hundred cases of ophthalmia neonatorum , Observed in private pract ice and an equalnumber treated in the Cincinnati Hospital . I have

‘now to add to that number fifty cases,from private

;and seventy-seven cases from Hospital practice .Of the former, five cases ( ten per cen t.) were

Ablind in bat"; eyes when firs t seen , and eigh t cases

( s ixteen per cent. ) were bl ind in one eye . O f theseeight cases

,six had good vis ion in on e eye

,and two

had leucoma adherens. In both ofthe latter casesan iridectomy was successfully made

,giving the

p atien ts a moderate amount ofvision . The corneawas sl igh tly infi l trated and haz y in three cases ( sixper cent.) but'all Of these did wel l and the corneac leared up under treatmen t.Ulceration ofboth corneae i s noted in three cases

[ (six per cent. ) and one ofcornea in two cases (fourper cent. ) bu t al l of these made a fair recovery.

Macular cornea more or less pronounced remain ed,

but there was a reasonable prospect ofth e corneaebecoming so clear, as to gi ve the patients usefulv 15 1on .

Leucoma adherens affecting one eye ( the othero n e remaining sound), occured in two cases (four“per and in thes e there was a chancefor ani ridectomy in the future. In twenty-seven cases

(fifty-fou r per cent) , the corneae were clear andintact when firs t seen , and these all made a goodrecovery, no corneal complication-aris ing during thec ourse Of treatment.These fifty cases taken with the one hundred

p reviously reported, show a total of per cent.blind in both eyes, and per cent. blind in onewhen first seen . Only per cent. of the totalnumber were free from corneal complication when

v i"

mination ofth e disease,depended entirely on th e

treatment to which they were subj ected. In th ehospital the treatmen t was commenced immediatelywithout the loss Of a single day

,wh il e those treated

in private practice, were either in the hands ofignorant m idwives and nurses

,and not treated at

all , or were subj ected to irrational and ineffi cien ttreatmen t at the hands ofthe family phys ician .

In order to test the efli ciency of the treatment inth e hospital, experiments were made in th is manner. Two cases ofophthalmia neonatorum

,as

nearly alike as possible were chosen . In one th eordinary treatment was carried out

,while the other

was allowed to take i ts course for a while. Theresul t was, that whil e the former improved, th elater became gradually worse every day that treatmen t was neglected.

The resul t Of these cases in hospital and privatepractice, goes to show quite conclusively , that ifa proper treatmen t is insti tu ted early

,before any

corneal complications have arisen,that the termi

nation is invariably favorable . Are we not therefore compelled to blame either the midwife

,or th e

nurse, or the physician for the unfortunate results,which we have recordedI append the treatmen t which was given in th e

former art icl e.The treatmen t of these cases

,which is carr ied

out almost entirely by the in ternes under thesupervision Ofth e attending oculis t on duty, i s w i thl ittle variation as fol lowsThe eyes are cleansed every hour or half hour

,

or even Oftener in cases where the discharge isvery profuse

,by gently separating the eyel ids with

the fingers and removing the accumulated pus witha soft rag or camel ’s hair brush . A solution of alumgr. ij. ad . aqua 35 5 . or Of argen t. nitrat . grs . ij . ad.

aqua gj . was d ropped into the eye every hour or two .

Cold compresses are used in many cases . Theyare generally wel l borne and are grateful to thel ittl e patients . They must be changed frequentlyin order to accomplish any good

,but care must be

taken in del icate children not to abstract too muchheatEvery morning the eyel ids are everted and

brushed with a solution ofargent. n itrat. grs . v. ad .

xx ad. aq . dest. gj. according to the severity ofth ecase, and the l ids washed Offwith tepid water.Unless th e swell ing ofth e l ids mechanically prevents it, th e cornea is inspected dai ly in each case.As the case improves the interval between the insti llation s of alum and argent. n itrat. is continuedin a weaker or stronger solution , un t1l every trace Ofthe disease has disappeared.

The greates t stress is laid upon the thoroughcleansing ofth e eye in the acute stages ofth e disease

,and th is is attended to, not only by day bu t

by nigh t.To th is par t of th e treatment

,do we owe th e

immunity Of the cornea from ulceration . The pus

27 6 THE CANADA LANCET.

i s neu tral iz ed or coagulated by the action ofthenitrate ofsilver and alum , and its corroding effectsthus prevented.

Another important poin t in hospital treatmentis that the cases receive attention z

’

mnzedz’

a/ely theslightest swel l ing ofth e l ids i s not iced , and theseverity Ofthe disease is probably thus d iminished .

When the l ids are very much swollen their evers ion is an easy matter. Sligh t pressure with the tipof the index finger

,upon the l id near the edge of

the orbit,will generally suffice, or a probe or the

handle ofa camel s hair brush may be used insteadofth e finger. As the l ids get th inner their eversion is much more d ifli cult. Then it is better toseiz e the cil ia between the index finger and thumb,or

,th e loose skin near the margin ofthe l id , and

draw it a l ittl e down and out from the ball, and atthe same time make pressure upon the upper edgeofth e tarsus, which if properly directed eas ilyeverts it.The best plan isfor th e operator to lay the c hild

across the nurse ’s lap and takes i ts head betweenhis knees

,after first protecting them with a towel .

In th is way he can control the motion ofthe child’shead most easily, and make the appl ications mosteffectual ly.”— Lancet and Observer C in . Dr . Agr es .

LITHOTOMY BY THE R ECTANGULARSTAFF.

By G EO R GE H. B . MAC LEOD,Esq , R egiusProfessor ofS urgery, U n iversity ofG lasgow.

[In the year 1 848, Dr. Buchanan , ofGlasgow,publ ished his paper explanatory Of the Operationby means of the rectangular staff(R etrospecf, vol.xvii

,Jan . to June , 1 848, p. 2 1 4, Eng. ed.) This

Operation has,however

,never come into use in

other places,notwithstanding its obvious advan

tages .]In Glasgow the rectangular s taff is almost exclu

s ively employed, and confidence in i t has steadilyincreased from year to year

,wh il e I do not think

it has ever been fairly tried elsewhere, unless I except its occasional use by Mr. Hutchinson in London . I cannot but hope that if its meri ts werebetter known it would be adopted by the professionin general throughout the country .

In the original paper the author tells us how hewas led by a perusal ofDupuytren ’s Memoir orLithotomy to institu te experiments, and how

gradually he came to fash ion his n ew staff, andadopt the improved method ofpenetrating into thebladder and d ividing the more external parts .”The staff used by Dr. Buchanan is bent at righ tangles three inches from the point, and is hence“ rectangular.” I t has a lateral groove alon g thehoriz ontal part, and the end of this groove is closed.

When the instrument is introduced, the angle l ies

ofthe anus. The horiz ontal part l ies parallel tothe rectum , and extends into the bladder.In operating, the staffi s so held as to occupy

an intermediate position between being hooked upunder the pubis and being pressed down on the perineum , and the Operator keeps it steady and distinguishes i ts correct position by placing his leftforefinger in the rectum under i ts horiz ontal part.The thumb ofthe left hand is at the same timepressed gently in front of the anus, so as to markthe si te ofthe angle and to keep i t steady. Theexact position ofthe angle i s very easily determined

,as there are only the skin , superficial fascia ,

and some fibres ofthe sphincter between i t and thethumb . The knife used is a straight-backed one,whose blade exceeds in length the grooved portionofthe staffby about one-fourth ofan inch . The

point is sharp,and i t should have a cutting edge on

i ts backfor about half i ts length , by which the ;

tissues along the groove are more surely dividedtowards the middle l ine ofth e perineum . Theshoulder of the knife is low

,and the breadth ofth e ;

blade equal from shoulder to h ilt.When the patien t has been t ied in the usual .

posit ion,and the staff placed as above described,

and fixed by the operator’s left hand the knife,(held short and above the hand, palm upwards) i s .

slowly inserted just above the anus j ust where themucous membrane shades into skin

,and close to

the raphe. The edge i s turned to the left s ide ofthe perineum; or to the operator’s right . The bladeis n ot in troduced parallel to the horiz ontal part ofthe staff (which would greatly increase the risk ofi ts escaping from the groove as i t passed on intothe bladder) , bu t obliquely, so as to impinge on thegroove at an angle and as it is afterwards pushed

,

on towards the bladder, a slzg/zt obl iqu ity is stil lmaintained

,so as to assure the operator that the

point is in the groove,and to ensure its non-escape

therefrom . In th is way the whole length of thegroove is traversed

,and the point Of the bladefi nally arrested by th e closed end ofthe staff. I t

‘

is then best sl ightly to withdraw the blade and to

complete the div ision ofthe soft parts as i t i sbrough t ou t, the knife being lateral ised andmade to cu t in a semi-circular d irection between theanus and the tuberosity to a point rather behind .

the l evel ofth e anus . The whole cut may measurefrom 1 I/é to 1% in . ,

according to the developmentofthe parts. I t approaches

,says Dr. Buchanan, .

“ very nearly to one-hal f ofDupuytren ’s incision ,only i t l ies much nearer the rectum , and though

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278 THE CANADA LANCET.

the staff was rigid at the angle the heel had to bekept small

,as it was in passing i t through the

meatus,and In conducting i t and the point along

the canal that the d ifli culty lay, bu t with the h ingeat the angle a large wide heel can be easily passed ,and so made ava ilable. I have used this new instrument four times on the l iving with great satisfaction and the hearty approbat ion Of those whohave seen its s implici ty ofaction — The Lancet.

FRAC TURE OFTHE FEMUR IN CHILDREN.

In a cl inical lecture delivered at the Bellevue Hospital (New YorkM ea

’zcal R ecord , j anuary Prof.

Frank Hamil ton observed that the pathology offracture ofthe shaft ofthe femur differs as i t occursin children as compared with adul ts . In adultsthe fractures are almost always Obl ique— very ob

l ique the l ine offracture is relatively smooth,and

the fragments overlap very much ; while in children the fractures are Often n early transverse, d enticulated , and not unfrequen tly, especially in veryyoung children

,only partially separated , and not

at all overlapped— in short, they are apt to partakemore or less ofthe character ofth e green stickfracture. If overlapping occurs

,i t i s usually to a

l imited extent, because the muscles have so muchless power to cause displacement in th is direction .

The fragments are bent or thrown out ofl ineeasily

,but there i s l ittl e or no displacement in the

l ine Of the ax i s ofthe bone.Prof. Hamilton believes that these differences

have not been suffi ciently borne in mind by surgical wr iters when directing the treatmen t ofthesefractures in children . They seem to consider thesame procedures appl icable to them as to adults

,

while, in fact, the indications are reversed. Thus,

in the adul t the first and most diffi cult indicationis to overcome the shortening caused by the Obl iquiry ofth e fracture and the powerful action ofthefully developed muscles, and the second is to keepthe limb in l ine. But in children the first andmos t d ifli cult indication i s to keep the l imb in line

,

and the second is to overcome the act ion of themuscles

,or th is second indication may not be pre

sent at all . The double inclined plane is totallyunsuitedfor the treatment ofthese fractures inchildren . I have tried these mach ines Often i n

my earl ier experience, and they gave me infinitetrouble and disgu st. They had to be readjusteddai ly, and if I got a good result it was a mere matter ofaccident.” The plaster-of-Paris bandage

,in

which the l imb is placed in a straight position,is a

dangerous appl iancefor ch ildren, and that in proportion as the child is younger— the danger ofstrangulating the tissues and producing gangrenebeing greater. Bandages Of any kind

,indeed

,ap

pl ied with sufficient tightness to support the boneswhich l ie deep in the soft and y ielding tissues

,are

l iable to cut Offthe venous or arterial circulation .

Moreover, they soon get loose and became fouled

or ingenuity be employed,excoriate the del icate

skin Ofthese l ittle patients. The straight posi tion—with short side pulleys and weights

,wh ich con

s ti tute the best apparatus for adults— fails in thecase ofchildren , owing to the restlessness ofsuchyoung subjects constantly disturbing the fragments

,

and lead ing to vicious union .

To meet these diffi cul ties, Prof. Hamilton devised an apparatus wh ich he has now employedwi th most sat isfactory resu lts for twenty years .This cons ists in a double thigh spl int

,connected

below by a cross-bar, and which is figured in thelast ed ition ofErichsen ’s System ofSurgery.”Each spl int is about four inches wide and half aninch thick, and extends from with in two or threeinches of the axillae, to four or five in ches beyondthe bottom of the fee t. These spl in ts are sounited by the cross-bar that they are separated from each other farthe r at their lower than attheir upper extremities by two or three inchesthus, by keeping the legs a l ittl e more asunder,preventing the child in some measure from wettingthe dressings. The spl ints must be wel l padded tofi t al l th e inequalities ofthe sides ofthe body andthe l imbs. So prepared

,the double Splin t is laid

on the bed enclosing the body and legs ofthechild. The sound l imb is first secured to the splin tby successive strips ofroller from the foot to thegroin

,and, after extension, the inj ured limb is

treated in a similar manner. The short or coaptation spl in ts (consisting ofth in wood

,cloth

,felts

or binder’s board, etc. , and l ined with some l int orwoollen cloth somewhat larger than the spl int) arenow appl ied , or may, if there be contusion or swelling, be delayed for a few days. The fron t or topone must extend from the groin to half an in chfrom the patella , which i t should never touch .

The outside spl int extends from the top ofth etrochanter major to the

,external condyle

, or lowerif the fracture (usually at the middle) i s low down ,and the ins ide one from the groin to the internalcondyle. The back splin t must be firmer

,wider,

and longer than the Others, and should be made Of

heavy sole-l eather or wood . The l imb is to res ton this as a sort Of bed, and it ought to extendfrom j ust below the tuber ischi i to three or fourinches below the knee. I t should be carefullypadded for the inequal i ties

,and covered with cto~

ton -cloth to keep the padding in place,andfasten

the circular bands to. Three or four inches or

more ofthe upper end may be covet ed with oiled.silk . The centres offive or six strips ofcottoncloth , each about one inch wide, are to be stitchedto the back of this fourth splint

,and

,the spl ints

all being in thei r proper places,the s trips are to be

brought around them , and tied in bows over thefront spl int. The long spl int is not to be includedas there would be danger

,when the body sinks

upon the bed, that the thigh might bend at the

THE CANADA LANCET.

broad band is now passedth e top of(and including)another broad band underhole for d efmcation . The

upper band keeps the ch ild in th e recumbent position , and supports h is back when he is taken up

ch additionalquickly (genis prudent to

keep on the apparatus five or s ix weeks,and not

even then allow the child to walk. I f you followmy directions carefully, and take the proper pains,looking after your patien t daily

, you will alwaysget s traigh t legs, and in most cases there will be noperceptibl e shortening, what l ittl e that may occurnever causing th e sl ightest halt in the gai t. Th ishas been my uniform experience s ince I began touse this dressing, and I have u sed i t now for morethan twenty years .

”-Mcc1. Times and G az etr‘e.

PUERPERAL SCARLATINA.— C . M .

,AGED 28

,pri

m ipara, was del ivered ofa l iving female child ofordinary dimensions on October 2 1 5 t. The labourwas tedious

,l as ting about th irty-six hours. The

head presented the placenta and membranes cameaway entire in twenty minutes

,th e uterus remain

ing firmly contracted. The mother did un inter

rupted ly well until 1 0 P.M. on the nigh t ofOctober26th, when she complained Of sore-throat and sligh tsh ivering, and vomited repeatedly. On October2 7th , she was feverish, restless, del irious during thenigh t ; the vomiting continued ; th e lochia werevery scan ty and extremely offensive ; there wastotal suppression ofmilk. Light-coloured offensivestools were passed two or three times during theday. Her mother

,at 1 0 A.M .,

noticed her face andhands to be ofbrigh t scarlet colour

,but Omitted to

examine her body. On October 28th, she had beenvery del irious th e preceding night. Her medicalattendant saw her at 1 1 A.M .

,for th e first t ime after

the morn ing ofOctober 26th , and found her coveredal l over a well maked scarlatina rash . Temperature 1 03 . 2 deg. pulse 1 28 . At 7 the tem

perature was d eg. On October 29th, shewas very restless and delirious 1n th e nigh t unt il 2A.M .

,when she became qu iet .

I saw herfor the firs t t ime at A.M.,and

found her lying on her back,with dilated pupils,

face pinched , l ips blu ish the tongue was dry andbrown ; the throat dusky red ; the whole ofherbody, with the exception Ofthe face, was coveredw i th a scarlatinal rash ofa dusky scarlet colour ;there were purpuric spots about the extremities ;th e hands and legs were ofa blu ish colour ; themuscles were very soft and flabby. There was notenderness or distension ofthe abdomen . She waspul

‘

seless. Temperature d eg ; resp irations48, shal low, laboured, and sighing. S he was conscious, and , when asked if she fel t any pain , answered i n the negative . At 1 she was uncon-rscious, the whole ofher body assuming a l ividcolour. Temperature deg. She d ied atN0 post mor tem examination was allowed .

R EMARKS — It i s an interes ting case,inasmuch

as the woman lIved long enoughfor the scarlatinato fully d evelop i tself. I t bears out the opinionsof Drs . Snow , Beck, Meadows , and others,

“ thatscarlatina does not change and produce only‘ malignan t puerperal fever

,

’ bu t i t retai ns i ts spe~cific characters i n th e parturien t woman.

”

(W THaines, M .R .C .S .

,London Lancet. )

[A case almost exactly s imilar to the aboveoccurred in th is city a short t ime ago. The rash

appeared on the firs t day after confinemen t andthe patien t died on the 7 th day — ED. L.

D IAGNOS I S OFTHROMBOTIC OC C LUS ION or ONE

OFTHE CORONARY ARTER I ES .-Dr. A. Hammer,

Professor ofSurgery at S t. Louis,at present at

Vi enna,publ ishes in th e mener M edez im

’

sc/i c

Wocfienscfir z’ft (February 2 ) an account ofa case in

which the above condition was diagnosed and verified by post mor tem examination . The man

, 34years O ld

,strongly buil t, had for the pas t year suffered from slight attacks ofarticular rheumatism

,

but no valvular affection ofth e heart had occurred .For four weeks previously to his being seen by Dr.Hammer

,a very sharp attack ofacute rheumatism

had existed,bu t had gradually improved

,and con

valescence was proceeding. One day he got out

ofbed, and sat in an easy chair. In about an hourhe suddenly collapsed

,his pulse was 40 , his l ips

pal e and a l ittl e cyanotic there was sl igh t dysp«noea

,but no pain . Five hours later his pulse

beat only 23 to the minute,four hours later 1 6 toth e minute ; and when Dr. Hammer arr ived ( thepreviou s observations having been made by th efamily medical attendant) the pulse was only 8 to

the minute,a cardiac contract i on occurring every

eigh t seconds. There were no symptoms or signsofdisease in the nervous or resp i ratory systems ;p ercussion ofth e precordia showed no abnormaldulness. O n auscultating the h eart, the soundswere not accompanied or replaced by any murmur

,

but follow ing them there was a tremor ofth e heartperceptibl e to the ear, conveying the idea ofa clon ic Spasm

,which lasted five seconds, the cardiac

280 THE CANADA LANG ET.

sounds occupying one second, and the spasm beingfollowed by two seconds ofabsolute rest. Thesephenomena were followed for twenty minutes

,and

were quite regular and without variation . Exam i

nation ofthe abdominal viscera and ofthe cervicalregion gave negative resu lts. In arriving at h isd iagnosis Dr. Hammer was able to exclude fattydegenerat ion and enfeeblement ofthe heart by thephys ical signs

,al though perhaps at present we are

not in a position to define exactly the signs ofthese affections . Alterat ions of innervation

,he

says, were contra-indicated by the absence of al levidence ofchange in the central nervous organs

,

or in the cervical nerves ; ofan acute infectiousdisease there was no evidence the percussion of,th e heart and the exam inat ion of the thorax generally negatived the idea of any altered relations ofpressure or ofany organic affection ofthe heartsuch as myocarditl s , endocarditis, hypertrophy,atrophy, or valvular disease. The stri king featurei n the case was the suddenness ofthe collapse

,

which pointed to a sudden interference with thenutrition ofth e heart, poss ibly to thrombotic occlusion ofthe coronary arteries ; further considerationconvinced him that

,though th is was probable, only

on e artery could have been occluded , or the heartwould have come to a stop altogether

,while the

r egular tumul tuous heart-spasm offive seconds’duration pointed to a one-s ided affection . Theaffected s ide acted as a d ead weight to the organ

,

and impeded the movements of the sound half,

but whether the affected S ide was righ t or l eft noc onjecture seemed possible. Dr. Hammer accordingly made h is diagnosis , much to the aston ishmen t ofh is colleague . The patient died nine teenhours afterwards ; and, leave to make a partial examinat ion Of the body having with difficul ty beenobtained

,th e thorax was opened. The lungs were

engorged and oedematous ; the pericardium contained half an ounce ofclear serum the heart wasofnormal s iz e and appearance, and lay _

in its proper posit ion, fully d istended. I ts surface wassmooth and sh in ingfand , except a layer offat inthe conorary sulci, there was no trace of fatty orother infiltration . On removing the heart

,theyfound the right auricle and ventricle full of clot,the

cavities and valves normal ; the muscular wal l andendocardium were also normal . The left side ofth e heart was equally so , except the aort ic valves .In these latter the most striking appearance wasthe disten tion ofthe right cusp by a mass whichnearly fi l led the righ t sinus ofValsalva

,and was of

a hemispherical shape. The superficial layers ofthis mass, followed into the coronaryartery, wererecent coagulated, yellowish white blood-clot, butdownwards from the conorary artery the clot h ecame darker, drier, and finally ofa grey-reddishcolour. From the lowest layer a fine thread aboutan inch long passed, to become connected with thenew growths about to be described. The aort ic

valves were not th ickened , but the hinder cusp wasuni ted to the right and left cusps at the i r commissuresfor a short distance. Involving these attachments and the three-cornered part ofthe wall of theaorta immediately subjacent, werefresh, soft, whitishexcrescences , which , with the sligh t adhesion ofthe valves, caused a partial stenosis ofthe aorticorifice. From the apex Of one ofthese vegetations s ituated between the posterior and right cuspsthere was a slender prolongation

,which was con

tinuous with the fine thread—l ike process'from the

clot in the sinus ofValsalva.

Dr. Hammer says he has not been able to mee tw i th an account ofsuch a case in l iterature

,nor

has he found that the great cl in ici sts , Bambergerand Kussmaul , with whom he has discussed thecase have had any simil ar experience — Lon . Mea

’.

‘

A NEw TREATMENTFO R '

LU MBAR ABS C ES S .

O sman Vincent has treated eighteen cases oflum~

bar abscess by the inj ect ion (after evacuation ) ofsulphurous acid. He selects two cases as examples :the first was cured in two months and ten days

,the

second in twenty days. The other cases weresimilarly successful

,the only difference being in the

amount ofpain caused by the inj ection,wh ich was

sometimes severe,bu t often altogether absent

,and

in the character ofthe constitutional disturbance,

which was either slight or total ly wanting. Therewas one

‘

point upon which he asked the opinion ofthe meeting th is was, that as a rule, the inj ect ionwent in colorless and came out black this wasmost marked in the cases that succeeded best.He concludes as follows The sulphurous acidacts on the pyogenic membrane in such a manneras to prevent the format ion of pus

,and if strict t e

cumbency is made an essential part ofthe ‘

treat

ment, there is no reason to fear that this dreaded ,but, i f taken in time, avoidable complication of angular disease

,may , by th is treatment, be shorn of

much,i f not all , i ts previous destructiveness.

”

T/ze Med ical P ress and C i rcular , December 26 ,1 8 7 7 .

—Medz°

cal R ecord .

U SE OFTHE AC TUAL C AU TER v IN S C IA’

I‘

IC A.

We learn from T/ze Lancet that M . M ichel Peter,Of La Pitié

,prefers the employment ofthe actual

cautery to any other means of_treating sciatica . A

case is related in wh ich,wet cupping having af

forded but sl ight rel ief,a number ofsuperficial cau

teriz at ion s were made by an ol ive-headed cauteryalong the course Of the sciatic nerve and i tsdivisions

,from the trochanteric region to the outer

malleolus. About twelve Of these cauterizationswere made . M . Peter considers th i s treatmentpreferable to bl istering

,because ofbe ing enabled

by it to fol low the whole course ofthe nerve, wh il sti t d oes not produce suppuration or lead to anyvesical trouble. I t may also be repeated, if necessary

,with impunity.

— M ea’. ana

’

S urg . R epor ter .

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282 THE CANADA LANGET.

CONTAGIOUSNESS OF PHTHISIS.

The following notice ofa paper by Dr. Tappein

_

er, read at a meeting ofGerman naturalis ts andphysicians, at Monaco is translated from Lo

Sper z'

rncntale,

”ofJan . , 1 8 78.

— All physicians have

observed cases ofphthisis rapidly developed in individuals who had for a long time attended on

patients in th is disease, even when such attendants

had not presented any predisposi tion , either indiv

idual or.

hereditary. Dr. Tappen ier believes that

the explanation ofthe fact i s to be found in theinhalation of the expectorated matter

,scattered in

the .air by the cough ing of patien ts. In order to

test th is Opinion , he . made experiments, by intim

at ely mixing a certain quantity ofth e sputa in al ittl e water h e pulveriz ed this emuls ion by an apprOpriate proces s, and subj ected some animals to

the inhalation of th e substance during one or two

hours every day . These experiments were madein the Anatomico-Pathological Institute ofProf.Buhl Of Monaco. Dogs were selected

,as animal s

presenting the leas t predisposition to contraction ofthe d isease . Three perfectly sound dogs were put

into the pen ofth e institute ; the pen is situaten ear a window, and is closed in all parts, excepting

above, where it receives the external air, through adoor which is furnished with a fastening.

A Some

sputa was Obtained from a patien t in phthisis,a

spoonful Of wh ich was mixed in a quanti ty Of

water‘

suffi cient tom ake of it, a l iqu id similar to

almond milk, and every day pulverization ofth iswas made in the pen during an hour

, or an hour

and half. -At'

the same time,for the purpose of

studying absorpt ion , by the digestive-

system, ofthe

tuberculous matter, two fofthe dogs were made to

swallow a certain quantity ofi t,from . the samepatient.

The whole five dogs had apparently a good ap

petite, ano presented neither cough nor diarrhoea

they ate freely, and were cheerful and nimble, without any symptoms ofi llness

,unless a sl igh t wasting

_and arrest ofdevelopmen t. At first view

,there

fore, th e experimen ts gave a negative result. But

th e day preceding the firs t autopsy,a l ittle finely

powdered carmine was mixed with the tuberculou sl iquid, in order to discover how fa r i t had pene

trated into the respiratory passages. Two ofthe.dogs subj ected to inhalati on , and

‘

the two :whichhad swallowed the tuberculous mixture, were ki l led

the end ofthree weeks.The resul ts

The five dogs presented a

culosis ofboth lungs, of the(at least in the two that hadculons matter,) ofth e digenumerous stains ofcarmine

The m icroscopic examination made by Professor

Buhl establ ished , in the cleares t manner, the real ity

ofthe lesions.I t has therefore been established experimentally

that in the dog a general mil iary tuberculosis can

be induced from the inhalat ion , or the ingestion,of the matter expectorated by a phth isical patien t.The possibility ofcontagion of phthisis throughthe natural channels, may th erefore be concluded.

The_hygien ic and clin icai consequences ofthe

experiment are of h igh importance . And first of

all it is to be noted that those dogs continued i n

apparent sound health,despite the existence of

general miliary tuberculosis. I t is therefore pos

sible in man a mil iary tuberculosis may rest latent

during a certain time,and may not become a real

and declared phthisis,before the development of

foci of inflammation . But that which is of chief importance is the possibility oftransmission oftuberculosis from man to man.

In ordinary conditions,— that is to say

,— in fresh

and frequently renewed air, the matters expectorated , and suspended

' in the air,may not become

suffi ciently concentrated to have the power ofinducing tuberculou s infection . But when a certain

number ofphth isical patients reside together, andthrough fear Of cold

,or Ofdrafts, the place is .

but l ittle,or not at all ventilated

,may we not fear

that the expectorated matter will accumulate suffio

cien tly to become dangerous to heal thy persons,l iving in the same quarters Ought we not therefore, in thiS

'

regard to take precautions, sometimesneglected

, p articularly in the wards ofhospital s ?“I t is not perhaps prudent to recommend to con

sumptives, never to swal low the matter brough t upfrom cavities

,which may have a deleterious influ~

THE CANADA LANCET.

great

and may explain many points ofthe imquestion ofth e contagion of ph th isis .

”

BR ITISH MEDICAL BILLil l to amend the Bri tish Med ical Act, i s now

th e House ofLords in Great Bri tain,having

the Duke ofR ichmond. We

me to go through the B il l in detai l, but,th e following provisi on s. We observe

place,that the much desired scheme of

examin ing board for th e three kingdomsly abandoned in the presen t B il l,for th e

Oin t board, the B il l

or endeavouring to

by each body,by

laid down by -the General Medical

provided that every person desi ringered under th is act shal l be possessed

qual ification , i . e. a qualification to

without examiThe conj oin t

as it appl ies to

and diplomas,

approval. The College oflate meeting, indicated its in

such bestowal ofit s titles onege ofSurgeon s is l ikely to dorigh t wh ich the Bil l proposes

en , to clai m examin ation at the contherefore, l ikely to thwart the carryobj ect. ‘ The clauses gi ving greater

the profession and the public were

and will be warmly approved. The

ome wel l considered clauses for thedentists and midwives

,wh ich are

to all .

more immediately affect

THE B ILIOUS ATTACKS OF SPR ING.

The spring-time i s upon us, and with i t comes

the usual number ofcomplain ts ofbil ious derangemen ts

,with lass itude and weakness. I t must need s

be so,for th e body, fortified to endure th e exces

sive rigors ofa C anad ian ‘

winter, has been stuffedwith carbon-bearing fats, coddled, pampered andcalorified in every way ; swathed , of necessity, in

winter flannels and heavy gat inents , wh ich , being

stil l worn,tend to make the perspiration excess ive ,

and also to confine it, causing the body to abs orband re-absorb i t, to th e gr eat detrimen t ofthe system . I t i s not to be wondered at, therefore, thatunder these. favouring cond itions , many d i seasesarefostered.

By want ofproper j udgment in the transi tionfrom the rigors . of winter to the warmth of. spri ng ,the machinery becomes clogged; th e individualsuffers from headache, dyspepsia, i rri tabil i ty ofthenervous system

,bil iousness, depre ss ion ofspirits ,

las situde, &c. And so people go to their dai lyavocation s without z est or Sp iri t, but l ike the

veries t slave driven by the thongs ofn ecessityfi lled with morbid feelings ofvariou s sorts, and labouring under a peculiar phase ofdepression ofspirits

,attributed to the bad weather

,and in Can

ada famil iarly called tice blues.” As an Offse t to

this condition ofth ings , many peopl e r esort . to

a! ”

I ‘ l g‘

Colonial degrees or diplomas as shall have passed anexamination equal to or greater than , that requiredat th e time In the United K ingdom , to enti tle to

regis tration . Such Colon ial pract i t i oners ,as are

regis tered under th is act shal l b e entered in a separate alphabeti cal l is t ; but they have equal r ight san d privil eges with thos e registered as belonging

to the,

United K ingdom . This i s_a provision

which if i t become law, we tru st our Medical C oun

ci l wil l heartily reciprocate. The provis ion s ofthebil l al so permit Colonial graduates to pract ice on

l ines ofsteamers sail ing to orfrom British ports,withou t registration .

Machinery i s ‘also provided by certain clauses ofthe act for s triking from the regis ter the names -ofmembers gu il ty offelony

,misdemeanor, or in

famous,

”or disgraceful conduct in a '

professionalrespect. We hope soon to have similar provisions

incorporated in our Ontario Medical Act .

284

patent medicines,

d a’

flawmm . A l it tle reso

lution and afew dietary precautions, would preserve heal th at this time, as well as at others.

'F irstwith the change from cold weather

,there should

be the rigorous adoption ofmoderation in eating.

Hearty meals,largely made up ofmeat diet, tend

to surfeit the system and produce bile . The d ietshould be largely vegetable or fruit, and sparingly

ofmeat. Oatmeal and milk wi l l su i t well , butabove all , regular attention to the skin is abscilutely needful. Alcoholic beverages should be carefully avoided. Afew simple rulesfor th e management ofthe body in spring

,judiciously carried Out,

would in a great measure,prevent the occurrence

ofthese bil ious attacks, so common at this seasonof the year.

AcrrONFOR SLANDER.— A case was lately tried

at Owen Sound in which Dr. More of Thornburybrought an action against Mr. McKenny, chemist

and druggist of the same place,for slander. The

slander consisted in the statement, openly and re

peatedly made,that thedeath ofa patien t under

the care of Dr. More was caused by improper

treatment, and that h e could prove it in a court oflaw. The doctor requested him on two differentoccasion s to retract and apologiz e th is he refused

to do, and ins isted that the case should go to court,and stated that he was prepared to prove the

T he doctor had therefore no al ternative but to

go on with the case. There was not the sl ightest

foundation for the statements made by McKenny,

and when the case came up for trial , the plea ofjustification was dropped

,and the defendant pleaded

not guilty.

” The evidence,however

,went to

show that he had repeatedly made the s tatements

charged against h im. The j udge charged very

s trongly against the defendan t,and the jury brought

in a verdictfor pla intiffwith nominal damages,

the plaintiff having stated in h is evidence that hedid not seek damages. The j udge grante d a cer

tificate'

for full c osts .

I t would have i a most benefic ial effect,if a few

more such individuals were brought to book for

their reckless and wanton assertions,regarding

med iCal men in the treatment oftheir patients.

THE CANA‘

DA'

LANCET.

of the winter session, and resultedW. A. Dafoe, Trinity gold medal

Trin ity silver medal Chas . Sheard ,ulty gold medal D . H . Wilson , M

si lver medal. In th e final branches

year’s examination,Mr. Hatton took the fi

year’s s cholarship , value $50, and Mr.the second r st year’s scholarship, value $30.

Shore also passed this examination.

TORONTO MEDICAL SOC IETY. -A meeting

the medical profession in this city and vicinityheld in the Canadian Institu te on th

for the purpose ofDr. Workman wasGraham secretary.as to the name of th

ial Division Association ,-it was decided to

the former,and a committee was appoin

draft a constitution and by-laws, and to re

an early date.

D IALYZED IRON HYPODERM ICALLY. —ApOnderit in the Med . <5? S urg .

ph ia,has been using with gre

iron hypodermically,i

with irri tab il i ty ofthe

pledgetfofcotton with about th irty minims ofiron

,and introduced it in to the vagina where

mucous membrane offers a large surf ace for itssorp tion.

PHO S PHOZONE.— This new preparation of

TRIN ITY MED ICAL SC HOOL— ANNUAL Exam elixir of the hypophosphit

NAT]ONS . —The examinations were held at the close

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286 THE CANADA LANCET.

ATROPINE IN N IGHT SwEATs .— The use of gm” flnatmmtt

‘

i tzatropine in small doses , has been highly extol led oflate in the treatment ofn ight sweats ofphthisis

,

and other exhausting diseases. I t i s frequently

combined with morphine,as in the following

R AtropineMorph. SulphAcid Sulph . Aromat casil inserted and at the same timAquae ad

y

scarcely any danger of its sl ipping out.

Sig. F ive to ten drops at bedtime. I t has been

u sed in both the Montreal and Toronto General

Hospitals in th is way,with marked benefit.

PRESENTATION.— Dr. J . C . Mitchell ofClarke,

who is about to remove to Enniskill en, was pre

sented with a silver service accompanied with an

address by the good people ofClarke. The Dr.

made a su itable reply,thanking the friends on be

half Ofhimself and Mrs . Mitchel l for the kindnessthey had received during their residence in Clarke.

WR ITER’S CRAMP .— We have°

ust received a

circular and blankfrom Dr. G. M .

J

Beard, of“ New £ 001”Emil £ 31”t 15.

York,asking for facts relating to the symptoms and

history ofthe disease known as Writer’s Cramp.

”

He would be obliged,if those who are victim S '

Ofthis or analogous conditions would communicate

with h im,by sending any facts ofinterest in such

cases. Blanks will b e suppl ied on appl ication .

DR . MC INNI S,the new Member ofParl iament:

-forWestminster, B.C . ,has taken his seat in the

House ofCommons, O ttawa.BRAITHWAITE’S R ETROS PEC TFO R '

1 8 78.— Anyf

subscriber to the CANADA LANC ET who has paidhis

’

subscri ption'

up to January 1 8 78 , can have

Braithwaite’s R etrospectfor the current year, Jan:uary and July

, on remitt ing $2 to this office.APPO INTMENT.— Dr. E. W. Spragge ofToronto

has been appointed as the representative oftheUniversity of

|;l‘

rin i ty College in the OntarioMedical Council.

C oR ONERs.— J. T. Moore, M.D .

, ofTilsonburg,to be am Associate Coronerfor th e County ofOxford.

S . P. Emes, M .D .,ofDrayton, to be an Asso

ciate Coroner for the Co. of Well ington.

th e eye effectually prevents the hook-l iofth e eye from catch ing or tearing thethe needle is pulled through. Ontroublesome things in a protracted surgical Opera“

tion . is the frequent t hreading of needles . The

above mentioned form ofneedle will be foundtherefore

,a great desideratum

,and seems also well

adapted for general use.

R ER OR T ON HEATING AND VENTILATION o r THEJOHN HOPKIN ’S HOS P ITAL, BALTIMORE. BY

John S. Bill ings M. D., Surgeon U. S . Army.

The subj ect ofventilation ofbu ildings,whether

large or small,public or private

,is one on which

very vague or unsettled ideas seem to prevail,not

merely among the community at large,including

al ike the proprietors and tenants ofhouses,but

,

what is stil l more lamentable,a very considerable

proportion of architects and builders, who are regarded as duly qual ified to make every requisite

constructional provision for the convenience,com

fort , and good health , of the future occcupan ts of

their erections.

Dr. Billings has very properly discussed the sub

ject'

ofventilation in strict affi nity with the other,

in this country indispensable provision for comfort,

THE CANADA LANCET.

no better means ofan th e old -fash ioned

wi th disfavour,because ofthe expense ofkeeping

them in Operation— all heat expended in producingchimney draft

,is

'

held by such persons , as waste offuel

,and their great study is not to carry Offthe

heated foul air,but to retain i t— as the question

here l ies between the cost .of_

a l i ttl e extra fuel, anddoc tors? bills , , and our profession is much over

stocked, Our read ers may pardon us for avoidingenlargement on th is subj ect.We are pleased to see that Dr. B il l ings has given ,deservedly in i tal zks , a coup de grace to a delus ion

which has long obfuscated the brains ofquack venti lators . He thus writes I must also insist

upon thefact,well known to al l physicists and

chemists,but usually unknown to pseudo-scien tific

writers on venti lat ion, that carbonic acid is equally

d iffused throughout the room it does not col lect

that its sp ecific gravi ty

is greater than that ofair at the same temperature,has noth ing what ever to do wi th questions ofventilation in a hospital .”

Every medical tyro , who has been taugh t th elaw Of diffusion of gases , thoroughly understandsthis fact ; and yet i t has fal le n to our lot to be

sometimes pes tered with the inane del iverances

of'st ilt-walking offi c ials, pitch-forked in to positionsof sup ervi sion for which their ch ief, ifnot sole, ’qualification

,has been

,— well, l e t that pass every

bod y now-a-days knows that knowledge i s not

power, and that the possession of it, dissociated

from pol itical toadyism,or sycophanti c subservi

287

ency is abou t th e most hopeless recommendation to

execu tive approval which any candidate can Offer.Dr. Bill ings has suffi ciently d iscussed the relativemerits ofth e several modes Of ventilation whichare now availed ofi n hospital s and other in stitut ions. We Should be very glad to be able to givean extended resumé of his valuable experiments

and observations, bu t th is would be imposs ible in

an articl e so necessarily brief as a j ourn al istic

not ice .

Before, however, closing th is n otice,we feel

cal led upon to express our demurral to one pas

sage, wh ich , we fear, may be, by governors or

trustees oflarge public institu tions,wrested from

th e context, and most danger ously misappl ied.

I t relates to the numerical occupancy ofsick wards,

or other apartments. The words are

Whether a man has 250 or 2500 cubic fee t

(ofspace) th e amount offresh air requiredfordilution to a cer tain s tandard

,wil l be the same

after a very short time.

Now if'we fel t assured that in an overcrowdedhospital ward, th i s requi rement would be always

secured, or that i t could be secured without imm inent peril to th e occupants, we migh t not deprecate

even the dislocation ofthe above passage ; butwho does not know that overcrowded wards are

always defectively ventilat ed,and that it i s l ittl e

short ofmurderous to drop the most casual phraseon the harmlessness ofovercrowding, in the hear~ing ofpubl ic Officials, whose main study is to exhibit their own effi ciency by displaying in figures

ofdollars and cents, their h igh economic merits.PATHOLOG IGAL R EPOR T or CAS ES IN THE McN

TR EAL GENERAL HOSPITALFOR TH E YEAR ENDING MAY l st., 187 7 . By Wm; Osler

,

“ M. D .

Prof. ofPhys iology,McG ill Col lege. Mon

treal : Dawson Bros. Toronto : W illi ng 85W ill iamson. Price 7 5 c.

The author states in h is preface that one hundredautops ies have been entered in the post-mortembook of the Hosp ital , for the year end ing May l st

187 7 . In the report,brief summaries are given of

the cases of pract ical and scientific i nterest, together

with a synopsis of the cl inical features. The cases

are grouped under the . vari ous organs affected,as

the osseous system , c irculatory system,resp i ratory

sys tem,gastro i n test inal system,

gen i to-urinary system

,etc. S ome t

ofthe autopsies are of exceeding

interest,and we must congratulate the author upon

THE C ANADA LANC ET.

the care and pains-tak i ng labor bestowed on h isW t rk, and trust that he w i ll cont inue to give to theprofession annually a report ofh is labors in theautopsy room . Many of the post—mortem appearances

have been careful ly exam ined by the m icroscope,and aful l report is givgn where the cases were ofsuffi cient importance. The work is dedicated toDr

.Bovell

,Emeri tus Professor of Pathology in Trin

i ty Med ical School.A COMPEND OFD IAGNOS I S IN PATHOLOGIC ALANATOMY, WITH D IREC TION SFO R MAKING PO STMORTEM EXAM INATION S by Dr. J . Orth, Berl in.

Boston : H . O . H oughton 8: C o. TorontoWill ing Will iamson.

The above work is one which was very greatly

needed,for although much information may be Oh

tained from the ex isting works on pathological

anatomy, yet they are al l too diffuse for generaluse. The author gives practical details and cornprehensive directions for making post mor tem ex

am inations , and for recogniz ing pathological

changes and establ ish ing th e diagnosis. In the

directionsfor the performance ofautops ies, the newPrussian regulations for forensic physicians have

been closely adhered to. In the matter ofdiagnosisboth 2th e gross and micro scop ic appearances aredescribed. The work represents to a large extent

the teachings ofVirchow,whose assistant the au

thor was for several years. We can confidently

recommend th is work to those who require a guide

in the performance ofpost mortem examinations.THE PHYS IC IAN’S DAY-BOOK AND LEDGER . Pub

lished by Hart R awl inson,Toron to.

Thi s i s a‘

most conven ient system of book-keep ingfor med ical men . The day-book is ruledfor con

ven i ent entryfrom day to day. The ledger i sruledfor the entry of accountsfor seven years,and is SO arranged that one can see at a glance whatthe amount ofi ndebtedness is

,and the amounts

paidfrom t ime to t ime.

most conveni ent system of book-keeping we have

yet seen.

ON HEMATUR IA As A SYMPTOM OFD ISEAS E OFTHE.G ENITo-URINARY ORGANS . By 0. Hoff, M.D . ,

San Francisco. Ph iladelph ia : Lindsay andBlak iston .

BEITRAGE ZU R PATHOLOGI S C HEN ANATOMI E DES. AUGES . By Dr. Adolf . Alt, Trinity MedicalSchool Toronto.

THE R ELATION S EX I STING BETWEEN EC ZEMA AND

PS OR IAS IS . By R obert Campbell, M . D.,De

mil t Dispensary, New York. New York : G.

P. Potman ’s Sons .

ON THE R EC OGN ITION AND MANAGEMENT OFTHEGOUTY STATE IN D IS EAS ES OFTHE SKIN. ByL. Duncan Bulkl ey, A. M.

,M . D. ,

Demilt Dis

pensary, New York. New York ,. G . P. Put

man ’s Sons .

PARAC ENTES I S , AS PI R ATION, AND TR ANSFU S ION.

By S. Fi tch, A. M.,M . D. Edin . , Halifax N. S .

From the Transactions Ofthe International Medical Congress

,Philadelphia, 1 87 7 .

COPAI BA AS A D IURETIC .— In the case OfMme.

Titicu s,Drs. Spencer Wells and Howel l fail ing to

produce diuresis by the ordinary means,found co

paiba, in ten-grain doses to succeed remarkablywell .— Lemeet.

malts, gummata, attains.

At Bryanston, on th e 23rd ofMarch, the wife Of

It is w i thout doubt,the J . L. McDiarm id , Of a son.

In Brantford On the 23rd ult. , Levi Secord, M .D .

,

ofBright, Ont. , to Em ily C ., second daughterR EVELATIONS OFQuAcxs AND QUAC KERY. A ofWesley Morrell , Esq , ofBra

series ofletters by Detector,

” published in the In London,Ont. , on the 2 7 th March, G. H .

Medical Circular by F. B. Courtenay Seventh Case,M .D .

,to Lella Edith

,youngest daughter o f

edition , London Balliere,Tindal l C O . TO John Blackburn

,Esq .

ronto Clougher Bros.At Hamilton

,on th e 29th ofMarch , Of pneu

PNEUMO-DYNAM IC S . By G. M . G arland, M . D. mon ia, John Bell, Esq. A.M .,M .D .,

ofMontreal ,Harvard University. Boston : H . O. Houghton aged 33 years.and Company.

A SATCHEL GUIDEFOR THE VACATION TOURIST IN

EUROPE — A compact i t inerary of the Bri t ishIsles

,Germany , Holland, The R h ine, Swi tzer

land, France, Austria, and Italy , w i th maps.Seventh Edi t ion . Boston : Houghton OsgoodC O .

Th is is a very n eat and comprehensive l i t tle work,

and an adm irable tourist ’s gu ide. To those who

i ntend v isi t ing places of interest in Europe duringthe com ing summer we heartily recommend this

book . Price

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of ice to cool the mouth and al lay the thirst.

At 8 R M. the pulse was 1 1 0 and the reaction

moderate. Complained ofa dragging pain at seatof ped icl e. The bladder was empted every ,eight

hours with the catheter. Administered an anodyneinj ection per rectum (tr. op i i . 5 j. warm th in starch

gj. ) every four or five hours to secure freedomfrom pain . During the first n igh t she vomited once

only,and not afterwards. Had noth ing by the

mouth excepting ice to suck until the evening ofth ethird day

,when sh e was allowed fresh milk and

l ime water,iced

,in equal parts, a table spoonful

every hour. During the second night she had

some fever,pulse 1 20, lasting about five hours ,fol

lowed by a sligh t perspiration and a show” ofthemenses. The menses increased in quantity and

continued three days, notwithstanding that theOperation was performed the fourth day after theirnormal cessation . She had no pain after the second

night,and the anodyne InjC C LIOHS were omitted .

On the fourth day l ight nourishmen t was allowedin increasing quantites , and from th is time her con

valesence was continuously progressive.

The use ofthe catheter was discontinued afterthe fifth day ; the wound healed by the first inten

t ion the superficial sutures were removed on the

fifth day,and the deep ones on the ninth ; the

clamp came away on the 1 6th ; and on th e z r st,she leftfor home. Abou t two years subsequentlyshe was married to a builder ofthis city, and infifteen months thereafter I had the pleasure ofdelivering her of a fine

,large, healthy-looking son .

CAS E I I . U uz'

loeu/ar Ovarian Turnou t — Ovar i

ofomy .—Ad/zeszous . n alu res .

— P eu'zele secured

by theEx i t a-

per z’

tonea/ met/10d .— D rainage.

—1€e~

Mrs. K.,aged 25 years , married, the . mother of

three children— none ofthem living, a ' l igh t com

plexioned , fair-haired , del icate appearing woman ,under the care ofDr. O ’

Nei l, Of this city, At the

birth'

of her last ch ild ( 1 9th , Nov. her

med ical attendant mentioned that She had an en

largement ofthe abdomen , wh ich m ight be causedby an Ovarian tumour. About five weeks after the

confinemen t she was taken very ill,and the same

med ical gentleman attended her for an attack Ofinflammation ,” when he said the enlargemen t stillexisted. Subsequently the case passed into thehands tfDr. O ’

Nei l, and it was in consultation with

h im that I attended her. The tumour was ratherobscure as to i ts nature, rising nearly to the

'

umbi li

cus. I t was very protuberan t anteriorly,proj ect

ing, as i t were, from the pelvis as in pregnancy between the fi fth and sixth months. I t was dul l

under percussion,and fluctuation was very Obs cure.

( I have no note ofthe measurements. )Some weeks later another examination was made .

The tumour had somewhat increased in siz e,and

fluctuation was more distinct. The uterus was found

h igh up behind the lower margin of the tumour,the

sound passing in two and one half inches. The

tumour was then tapped with a hypodermic syringe

and abou t one drachm ofamber colored fluid

withdrawn,wh ich did not coagulate spontaneously.

Diagnosis. Ovarian tumopr ovariotomy recom

mended.

Ovariotomy was performed at I r A.M. on May

1 6th} 1 8 7 6. The tumour proved to be monocystic.On being tapped the contents flowed out freely andthe cyst was speedily emptied

,and easily brough t

through the incision,which was about five inches

in length . The omentum was found adherent to

the cyst in several places,and after being separated

,

bled so freely that we were obliged to have recourse

to several silk l igatures to arres t the hemorrhage.

The ligatures were all cut short and left in the peritoneal cavity. As some ooz ing of serum still con

tinned a drainage-tube was placed in the wound ,with the lower end down into Douglas ’s cul-de-Sac.

The pedicle being ofmoderate size and sufli cien t

l ength , i t was secured by a Spencer Wells’s clamp

,

and thus treated by the extra-peritoneal method .

At the conclusion Ofthe operation (according tothe notes carefully taken by Dr. O

’Nei l) the pulse

was 78, and gradually increased in frequency dur

ing the afternoon and even ing until it reached 1 1 0

per ni inute , the h ighest number recorded during theconvalescence. The temperature rose, the sameevening, to and with one exception when i t

reached 1 02,th is was the h ighest temperature t e

corded . In order to keep the patien t at rest andfree from pain two grains ofpulv opti were admini stered about every 6th hour, during seven or eightdays. The convalescence was progressive from the

time ofthe operation . During the first two days a

great quantity Of serum ooz ed from the abdominalcavity; coming out around the drainage- tube andped icle until i t saturated the folded sheets &C .

, be

low the patien t. On the 24th ( the 9th day) the

THE CANADA LANCET.

pulse increased to 108, and the temperature to 10 2.

U pon examination the drainage-tube was found full ,and turn ing the patien t on her side four ounces Ofvery Offens ive pus flowed away . The pulse , the

same evening,fell to 85 , and th e temperature to

ggg. During the following three days, the pat i entwas morn ing and evening turned on her side, and

each t ime a small quanti ty ofpus was d ischarged,and on one occasion some fleshy pieces”. No

disinfectant syringing was resorted to. The sutures

were removed, some on the 9th, the remainder on

the 1 3 th day, and with the last st itch th e clamp fel lOff. The pati ent was soon up and about, and fromtime to time

,reported herself as feel ing as well

as ever.

CAS E III. Ovar ian D i sease Ovar i

atomy— P ezz

'Ie/e treated by the Infra-

p er i toneal

M et/10d .— Par tz

'

al Euue/eatz'

ou . 7 tea and

Dropped . Drainage Tube—Fawn — R e

M I S S N.,from the county ofBrant

, ( th roughthe kindness ofDr. W. Corson ofBrantford,) consulted me on Nov. r st, 1 8 7 7 . Her health hasbeen rather del icate since her childhood

,but never

had any severe illness. Her digestion had always

been good until within three or four months, when

she noticed that She fel t ful l and uncomfortable

after meals,thi s caused her to seek the advice Of

Dr. Corson , who discovered that her abd omen wasconsiderably enlarged, due to the pre sence ofanovarian tumor.

For abou t a year sh e had been aware that shewas grad ually becoming stou ter, and at Christmas

( 1 8 76) her dressmaker remarked it ; but this didnot occasion any su rprise

,on th e contrary

,She

rather congratu lated hersel f, as she presumed

she was “ growing out ofher former del i cate condition .

P r esent state.— Ofmedium siz e, sandy complexion;

fairly wel l nourished . All the organ s and functions

ofthe body appear to be in a normal cond i tion.

Her friend s remark that She does not look so well

in theface as She did two or three months since

Plzys iea! agus.—_ Inthe standing position Sheappears

very much like a woman seven months gone in

pregnancy. The tumor is not very rotund and

prominent; i t i s rather flat, but entirely fill s up the

hypogastric, both iliac, and the umbilical regions,ex tending upwards three inches above the navel .Under pressure it res ists l ike afull sac

,but does

Girth at umbil icu sFrom umbilicus to ens. cart ilage

60 ( 6 pubesright a.s .s. process. 7left a. s. S .

,

6 6 6

not feel sol id l ike a fibroid . The whole surfaceyields dul lness und e r percussion

,and deep-seated

fluctuation is obscure ly el ici ted,with the exception

ofa large portion occupying the righ t il iac region,

where the tumor is hard and uneven . Simpson ’s

sound passes 2 1 2 inches into the u terus , in the l eft

lateral direction . The tumor is fel t by the finger,

on th e right side ofthe u terus . The measurements

are as follows

Tapped with a hypodermic syringe,th e cys t

yi elds a thin straw colored fluid,which is not

spontaneously coagulable .

Diagnosis. Ovarian tumor,—multilocular

,spring

ing from the right ovary.

M IS S N., having been in the city several days ,occupying her “ quarters,

” getting accustomed to

her lying-in room , and other surroundings ; th e

menses having ceased five days S ince and beingnow in al l respects in a pretty good and hopeful

cond i ti on the Operation was proceeded with .

The patien t having been chloroformed,and th e

abdominal section five inches in length made in

the usual way, the tumor was readily brought

into View ; the patient having been turned on her

left S ide, th e cys t was tapped with an ordinary

trocar,and the contents being th in , i t was rapidly

emptied ofabou t twelve pints ofthin straw-colored

fluid. The tumor was then brought through th e

incision withou t further enlargemen t, and found to

be composed of an aggregat ion ofsmal l cysts,

somewhat resembl ing the honey-comb, fil led with aS imilar fluid to that ofthe parent cyst. The

weigh t of the tumor and con ten t s was eigh t pounds .The pedicl e was very short, and had to be enu

cleated (according to Dr. Miner’s process) several

inches from the tumor, before suffi cient l ength wasObtained to permit Ofmanipulation. The sound

part was then ascertained to be too Shortfor th eapplication ofa C lamp , and recourse was had to“ tying and dropping. A double S ilk l igature was

passed by means ofa large needle through a th inpart near the centre Of the pedicle, and each hal ffi rs t secured separately, and then as an extra precaution one Ofthe l igatures was t ied tigh tly around

THE CANADA LANC ET.

the whole. The ooz ing enucleated portion was then

amputated by the actual cautery.

The pedicle, contrary to the diagnosis— based

upon the fact that the uterus was in the left s ide ofthe pelvis

,while the lower part ofthe tumor was

fel t on the righ t s ide— was found to haxe sprungfrom the left ovary. This anomaly was accountedfor

,when i t was found that the solid portion Of the

tumor had sent a proj ection downwards into thepelvis which had crowded the uterus over to the left.

As serum cont inued to accumulate in the pelvic

cavity, after i t had been thoroughly sponged , drain

age was provided for, by inserting a tube, before

closing the wound . After th is was accomplished

in the usual way, th e patient was placed in a good

comfortable bed with warmth to the feet. She

qu ickly rallied from the chloroform ,and as she

C imp lained ofsome pain , 40 drops oflaudanumwith a l i ttle brandyand iced water were admin i stered .

The pulse was now 7 2 and the respirat ions 38 . An

hour subsequently the pulse was 7 6 , and in two

hours 80. As she still compla ined ofpain , 50 dropsOf laudanum were given in a l ittle brandy and iced

water. She is now thirsty and is al lowed ice to

suck,but noth i ng to drink .

At seven o ’clock,

the same evening, reaction wasfound thoroughly

,establ ished ' Pulse 1 00 ; re

spiration 22 ; Skin warm and moist ; feels “ too

warm,

” notwithstanding th e hot bottles and some

of the bed cloth ing had been removed vomited asmall quantity

,once only, th is was about 4, p. m

Took away (per catheter) abeut seven ounces

urine. Said she fel t some pain , and was given

another dose oflaudanum with brandy and water,iced .

P .M.— Has not vomited S ince 4,

has S lept a couple ofhours ; feel s bu t very littlepain pulse 96; respiration 20; temperature r ooyE

Took away six ounces ofurine, gave enema beefe ssence gij, tr Op i i g ss , brandy g i j . To have

noth ing excepting ice by the mouth.

2sth, 8, A.M.— Had a very good night ; vomited

once ( th is morning) a l ittle greenish fluid slept

nearly al l n igh t,waked occasionally and had a

piece ofice ; pulse 82 , respiration I 8, temperature

Took away the urine,and repeated the

enema.1 . P .M.

— Has been comfortable during the forenoon

,vomited again about 33 0 , but no t S ince,

pulse 88 , respiration I 6, temperature roof. Took

the urine,and repeated the enema. As the drain

age-tube was nearlyfull,i t was emptied by sucking

g iij ofreddish fluid out, with the bulb of a syringehaving a small flexible tube attached. The tubewas then washed out by inj ecting a small quantityofwarm water, sl ightly carbol iz ed, and contain inga few grains of table sal t. This solution was im

mediately withdrawn by means ofthe syringe,and

the process was repeated several times until thefluid returned clear.6 P.M.

— Has not vomited since morning ; slept

about two hours pul se 96, respiration 1 6,tempera

ture 10 115° took away the urine ; repeated the

enema ; withdrew about z iij reddish serum from

the pelvic cavity,and washed it out, as previously.

1 P .M .— Has slept considerabl e since seven

o ’clock ; feels comfortable ; skin moist'no pain ;

no headache, but states she feels hot,pul se 1 06 ,

respiration 1 7 , temperature Took away the

urine, and repeated the enema; she has had thus farnoth ing by the mouth except ice.

26th,8 A.M.

— Had a comfortable sleep up tothree o ’clock this morning; s ince that time she has

been restless wi th a desire to urinate,has not

vomited since yesterday morning,and the stomach

feels settled , skin moist, pulse 1 02, temperature

Took away 311) urine,and repeated the

enema. Brought away 5 i i reddish serum andwashed out the dra inage-tube .6 E LL— Nurse states

,patient has had a fever

since 1 . p m . The skin i s dry and hot,pulse 1 23 ,

respiration 1 7 , temperature R emoved the

urine, and gave per enema, mutton broth gvj ,brandy 35 5 t incture opu. 5 5 s ,

sulphate of quin inegrs . xv. Ice to the head.

P.M.—Has slept soundly

,and perspired

freely; as soon as she awoke the p erspiration ceasedand the skin again became hot and d ry ; begs cons tan tly for ice when awake pulse 1 23 , respiration1 7 , temperature R epeated the last enema

,

with the exception ofthe opiate ; continued ice tothe head.

M IDN IGHT.-Has rested well, and slept the

most ofthe time since 9 p .m ., no pain , skin moist,pulse 1 26 , resp iration 1 7 , temperature 1 0 1 Took

,

urine, gave mutton broth,per enema and

by mouth , sulphate quinine, grs. xv, brandyiced water

, 3 i ij ., continue ice to the head, and iceto suck.

i 27 th . 8 A.M.— Has had a good night

, and slep t

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THE CANADA LANCET.

pulse feeble respiration 42 face pallid lower ex

tremi ties very oedematous and vomiting frequently. She begs me to do someth ing quicklyforher rel ief. You may do anyth ing

”

, says she,“ for

I can’t l ive I explained to her that she was tooeak to bear the Operat ion of ovariotomy, and that ,under the circumstances, the only procedure admis

sible was that of tapping. This she then urged me

to do immed iately. Therefore during that afternoon assisted by Dr. Malloch , I performed thatoperation with a common , large siz ed trocar, in the

median l ine midway between the umbil icus andsymphysis pubis. The contents, which came away

very slowly,were of a dark color, and ofthe con

s istance of syrup. When thi s cyst ceased to flow

i t was evident,from th e enlargement and fluctua

tion stil l existing abo ve the umbilicus, that one or

more cysts remained to be emptied. Withdrawingthe canula

,a long curved trocar wa s directed,

through the same orifice,obl iquely upwards and

pushed into another cyst , the contents ofwh ichproved to be th icker and more gelatinous than thoseoftheformer. These resembled soft soap in con

sistence and appearance.

The contents of the cysts being so tenaceous ,

notwithstanding the discharge was expedited by

pressure with the hands on e ither slde ofthe abdomen

,two hours were occupied in emptying them.

The matter thus discharged measured twenty two

quarts,or five and one half gallons . The operation

oftapping was very exhausting in the patient’sweakened condition , but nevertheless as the siz e of

the tumor was diminished, she several times ex

pressed herself as feel ing much relieved and thepale anxiousfare improved in color and appear

ance. The respirations decreased to 26 and the

pulse to 90. The tumor was now reduced to aboutthe siz e of

,and fel t verymuch like

,the womb contain

ing a large placenta after child-birth,but owing to ad

hes ions as we presumed, i t could not be presseddown into the pelvis.The vomiting which had been so dis tress ing

previous to the operation , persisted for the three

subsequent days, notwithstanding the fact that we

administered neither anaesthetic nor medicines.

During this time nothing but morsels ofice couldbe taken into the mouth , and for two weeks l ife was

sustained by rectal al imentation . Enemata ofbeef-essence, and other nutritive materials were

administered in quantities ofabout two to four

ounces at a time, every three or four hours. At th e

end ofa fortn ight her stomach began to bear al ittl e milk and l ime water, and by and by, two orthree raw oysters sprinkled with lemon juice

,and

other l ight easily digested food . On the 25 th ofthis month she had a sharp inflammatory attack

,

attended with acute pain in the right side, between

the ilium and the l iver,which fortunately was al

leviated in a few hours. From that time sh e slowlyimproved

,and with the improvement came an i h

creasing desire to have the tumor removed . At

each occas ional visit during the month of May, sh e

urged me to make up my mind to perform ovari

otomy. During th is month she had been up and

about the house, much improved , but still weak and

pale. The cysts had been gradually refill ing so

that she now measured 40 and 20 inches respec

tively, instead of46g and 26 previous to the tapping.

Keeping in mind the existence ofstrong ad

hesions and her unfavourable condition,I explained

to her and her fri ends the great danger and nucet

tainty of the operat ion under th e circumstances .To this she quietly remarked that theyfu lly understood al l that

,and again calmly argued that sh e

could l ive but a short t ime longer if the tumor

were not removed,and said she ardently wished

that th is should beattempted .

Seeing that the hot weather was fast approach

ing, and it being more than probable that she would

not survive th e summer months in that'

condition

I determined to yield to the patien t ’s sol icitationsand make the attempt to remove the tumour.Accordingly on June 3rd 1 8 7 3 , ovariotomy was

with diffi culty,accomplished. Chloroform having

been admin is tered,th e abdominal wall s being thin ,

the tumour was quickly exposed through an incision

about six inches in length , which was afterwardslengthened to eigh t inches. On attempting to pass acouple offingers between the tumor and abdom inlal parietes firm adhesions were found in everydirection . These as far as they could be reachedwere slowly separated with the fingers . The patientwas then turned upon her left s ide and the tumortapped with a large trocar and canu la, improvisedfor the occasion

,but as the contents were th ick and

came away very slowly,a free incis ion was made

into the cyst,w ith a bistourywhen the thick gelatinousmatter escaped rapidly. The tumor

,

* was then‘The tumor, when laid open , after removal was seen to

con s ist ofone large cavity surro unded by an a gregat ion ofsmall cysts in i ts walls , and bo re evidence ofgr oken downcysts in i ts interior.

THE CANADA LANCET.

slowly wi thdrawn through the incision whentwo broad bands were brought into view. One ofthese was the pedicle reaching from the righ t ovary

to the superior part ofthe tumor, while the other— a very broad band proved to be the bladder ad

herent by i ts posterio r surface and elongated up

wards. Considerable d ifli culty was experienced in

separating the adhesions between the bladder and

the tumor.

A piece of whip—cord was tied around the pedicle

and th e tumor excised ; a loop ofthe whip—cordserved for a . conven ient handle with which the

ped icl e was held by an ass istant until i t was pro

perly secured. Ooz ing ofbloody serum continuedfrom the ruptured adhesions

,and i t was some time

before the abdominal wal ls could be closed. The

ped icle was securely ligatured with whip—cord, at a

suitable l ength from i ts root, and transfixed in thelower part of the wound, by a large needle passing

through the centre below the l igature. The abdominal cavi ty having been very carefully sponged

,th e

wound was closed with silver wire su tures anddressed in the usual way. The patien t was then

placed in a comfortable bed,and an anodyne

'

ad

ministered per rectum . She rested very wel l that

n igh t remain ed very quiet did not vomi t ; com

plained ofnoth ing, and received small pieces oficewhen they were put in to her mouth . The next dayit was apparen t that she was not rallying from the

effects ofthe operation, and , notwiths tanding theefforts made to revive h er sinking pow ers

,she

gradually failed until she quietly and easily passed

away about nine o ’clock in the evening.

Thus ended what seemed a hopeless undertaking;but cases apparently equally hopeless had recovered

,

and as my patien t urgently requested that the attempt should be made

,I was unwilling she should

be left to her fatal disease without an effort beingmade for her rescue .

C AS E V.-Multi lorular Ovar ian Tumor .

—Per z'

to

m’

tz’

s . Obstruction ofthe B owel s. Ovar iotomy .

— Adlzes i0ns to Omentum . C lamp — Dr ai nage.

Mrs . W., Widow, aged 40 , ster i le, camefrom Ohio , and was admitted to the Hamilton City Hospital under my care June roth 1 876 .

States that she has never been a strong person ;has had a cough several years ; catamenia haveb een regular never has been pregnant four years

ago had an attack ofpneumon ia,wh i ch lasted ten

weeks ; l ast summer had typho id fever and was il lfive weeks. Her husband died in February last

,

and immediately after h is death she was taken with

nausea and vomi ting,which continued about two

months, at the same tim e she noticed that h er ah

domen was enlarging rapidly and she did no t know

but that she might be pregnant.

P resent sulfa — She is of medium siz e , sallow

complexion , emaciated , feet and ankles oedema

tous, abdomen considerably enlarged and presents

the appearance of a seven months pregnancy .

Skin cool ; tongue coated brown ; constipated ;pulse 1 06 t emperature 99 respirations 24 to

28,i rregular.

P /zy sz'

eal agus.— The abdomen is rotund , a de

cided protuberance existing anteriorly,and very

l ittle flattening out by sagging offluid to the flanks.Under palpation the tumor resists l ike a ful l sac.

The fluctuat ion elicited is of a deep-seated charac

ter, and can be made out over the whole tumor,with the exception ofa space of abou t four inchesin diameter

,situated midway between the umb ili

cus and righ t anterior superior spinous process ofth e ilium this region yield s th e sensation of hard

ness under percussion,and in it sh e has suffered

severe pain for three or four weeks. By vaginaland rectal touch th e lower margin ofthe tumorcan befel t and obscure fluctuation elici ted . The

uterus l ies high up beh ind the tumor, and measures

the normal two and a-half inches. Simon ’s recom

m endation ofexamining the tumor posteriorly bymeans ofthe hand in the rectum was not enforced.

The measurements were as follows

Circumference of abdomen at umb i licus

From ensiform cartilage to pubes 1 5umbilicus to pubes 7

1Aens. cartilage 7r. a. s. 8 . process 7l . a. s. s. 7%

The tumor was tapped with the h y podermicsyringe

, and abou t hal f a drachm of th ick syru py,s traw-colored fluid withdrawn. This was not spon ~

taneously coagulable. I t was subsequently examined by th e microscope, but the presence ofthedispu ted cel l was not discovered.

Diagnosis. Ovarian tumor which is probablypolycyst ic.

On the afternoon ofthe 13th she was suddenly

THE C ANADA LANC ET.

attacked with a sharp lancinating pain in the sol id

portion of the tumor to the right of the umbil icus,which rapidly extended over the whole abdominal

region,accompanied with vomiting, fever, and a

frequent pulse. In the course of two hours the

pulse ran up to 140, became small and thready,and the vomiting very frequent. The bowels had

been constipated since her admission to the Hos

pital . Ordered hot turpentine stupe s to th e abdomen

,and %gr. morph . sulph . every th ree ‘hours

if necessary,also a li ttle brandy and iced water.

y um 1 3th . The medicines and hot fomenta

tions gave great relief, and after getting the second

hypodermic inj ection she passed a comparatively

comfortable night, but vomited several times

through the course of the night and this morning.

The pulse is now 140 , but softer and ful ler.Tongue brown, furred. Bears sl igh t pressure over

the abdomen without complaining. Bowels not

moved .

Even ing— Condition improving. Pulse 1 40.

Tongue moist, and not so thickly furred. Does

not complain of pressure over the abdomen,ex

cept in the righ t hypochondrium . Ordered a turpentine enema

,and the hypodermic inj ec tion of

morphia to be repeated i f n ecessary. Continuethe iced brandy.

1 5 th.— Improving. Had a good nigh t after the

morphia, but the bowels were not moved by the

enema. Pulse 1 30 , softer and full er. Skin moist

and cool Considerabl e tenderness in the righ t

hypochondrium and has p aroxysms of pain threeor four times a day. Ordered the hypodermic injection to be administered when necessary to re

l ieve pain beef-tea,milk and brandy.

1 7 th— Continues much the same. No move

ment of the bowels. R est disturbed by at tacks ofpain on the right side of the tumor

, has had the

morph ine three or four times in 24 hours. The

menses appeared during the night— scan ty.

20th.-R ather more comfortable ; the s tomach

bears nourishment a littl e better ; th e bowels re

main obstinately constipated ; the oedema of thefeet and legs has subsided pulse 1 20 temp.

resp. 22.

2 2nd — At a consul tation ofthe Hospital staff,

th e critical condition of the pat ient —~the exis tingperitonitis— the probabil ity of disorganiz ing changestaking place within the tumor— and the sure and

certa in end rapidly approaching,having been re

cogniz ed,and a free interchange of opinion ex

pressed,ovariotomy wa s d ecided upon . The

Operation was commenced at noon in the presence ofthe faculty and a number of practitionersand medical students. Dr. Mullin administered

the chloroform in his usual careful and attentive

manner, and Dr. Malloch kindly acted '

as chief

assi stan t. The abdominal section was made fiveinches in l ength

,but this was afterwards increased

to'

seven inches. O n opening the peritoneumsome asci tic fluid flowed away

,and through th is

the blu ish-white gl istening tumor was recogniz ed.

As no adhes ions could be fel t with the fingers thepatient was now turned on her left side

,the pre

senting cyst seiz ed at the uppe r end ofthe incisionby a pair ofstrong long-toothed forceps andsteadied while being tapped with a large trocar

bu t through the canula of th is instrumen t the

jelly -l ike contents, assisted by pressure with thehands, came away so slowly that considerable time

was occupied in evacuating the cyst. After theparent cyst was thus l essened , several smaller ones

came into view, and were one after another laid

open freely with a bistoury and quickly empt ied .

Each ofthe smaller cysts was found to differ fromthe Other, both in color and consistence .

Though about one th ird of the tumor proved to

be sol id i t was thus suffi ciently reduced in siz e topermit i ts being extracted through the enlarged incis ion

, by traction with the forceps , assisted by th e

hands ofthe operator. Now it was seen that the

omentum was closely adheren t in several p laces to

the superio-posterior part of the tumor. Consider

able d ifl‘iculty was experienced in separating these

adhesions , which , on being accomplished,bled

freely. The omentum was then turned up and

carefully laid upo n a soft napkin placed across the

abdomen , and the bleeding points were secured

by the use of a number ofsmall s ilk l igatures .The l igatures wereal l cut short and the omentumwas immediately returned to the peri toneal cavity.

While Dr. Malloch was thus arres ting the hemorr

hage ofthe omentum, the operator was engaged

securing the pedicl e. This was found attached to

the right side,and being of mod erate length it was

first tied with whip-cord,near the tumor

,and the

latter cut away and removed . A loop was then

made with the cord,affording a convenient handle

with which to manipulate the stump. This was

treated by the extra-peritoneal method, —fixed ex

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298 THE CANADA LANCET.

digesting the nourishment very well,a more l iberal

allowance offood was permitted .

July r st — Pulse 1 24, temperature r o og. The

p i . t l€ n t is not looking so well— has a sunken ap

p earance . About half an ounce ofvery offensivepus was found in the drainage—tube

,also some pus ,

about the tube in the wound ; withdrew the pus,cleansed the wound

,and washed out th e pelvic

cavity,after which the patient appeared much

better.

July z nd T.

4th

The drainage-tube having beenforced nearly outoft he wound, was removed. The remaining

stitches, were also removed . The aid of thecatheter

,from this date was discontinued. Bowels

moved by the aid ofan enema ofwarm water.From th is date sh e gradually and continuously improved, so that by the 1 6th

,she began to l eave the

bed for a short time, and on the 3oth , left theHospital .

The measurements taken a few days previously,

were as follows

Circumference ofumbil icus . 23 inches .Umbil icus to ensiform cartilage. 5

( 6 £ 6 pubes 5process 4

5

For some days she had been wearing well -fittingabdominal corsets

,with cotton padding underneath

,for the ’

purpose of afford ing support, and preventing hernia through the recently healed c icatrix.

She remained in the city a few weeks before

leaving for home . During th is short t ime she improved rapidly, and subsequently wrote that she

was gradually getting stronger and stronger and

fleSh ing up again .

R EMARKS .—The special points ofinterest in this

case were— the low condition of the patient,and

the desperate nature ofthe case,ow ing to the

existing peritonitis - the probab il i ty ofd isorganiz ingcharges taking place i n the tumor— and the

obstinate obstruction of the bowels,due to pressure

and inflammation — the extensive adhes ions me twith duu ng the operation— the difficulty in arresting the hemorrhage— th e number ofl igatures leftin the peritoneal cavity— and the provision madefor drainage. In the after-treatment

,the exhausted

condi tion resul ting from frequent vomiting— the

fortunate result of restricting the fluid taken by the

q ,

mouth— sustaining nutri tion by rectal al imentation ,

— and the beneficial effect of establ ishing drainage“

in first permitting th e escape of a large quantity of,serum , subsequently affording an ou tlet for theoffensive pus, and lastly, providing a channel .through which the pelvic cavity could be washedw .th disinfectants

,on the advent ofth e symp toms

ofcommencing septicaemia. Above all the pleasing,

knowledge that the woman is now in excellent .health— her disease radically cured— and that she

bids fair to enj oy many years ofhealth and happiness.

I have given the history of this unusually iateresting case in pretty full detail, hoping that by '

thus showing under what truly desperate circum

stances , valuabl e l ives may be rescued from a

premature death, the benefits the operation has

already conferred may be yet further extended by

encouraging other surgeons to give the poor suffererthe only hope remaining ofescaping the inevitableresul t, should the tumor be left to fi nish its deadly

work .

In closing the appendix,for the present

,I can

n o t with too much emphasis re iterate my conviction

that not a l ittl e ofth e success ‘

wh ich has rewarded

the efforts of the operator,must be attributed to

the careful attention given to the minutest par

ticulars,which could , even remotely affect the

result. In th is connection,I desire to return

‘

my

warmes t thanks to my med ical friends , who so ablyassisted me l a bringing th is and other diffi cultOperations to a successful terminat ion .

That operator i s indeed fortunate,who can sur

round himself on such Occasions,with good an ato

mists , skillful surgeons, and learned physicians,wi th cool heads, alert m inds, and ready hands,anticipating every want of the operator

,and prompt

to meet any emergency. Such medical gentlemen,

I am proud to acknowledge, have always kindlyand cheerful ly rendered me their valuable assi stance .

PREGNANC Y AT E IGHT Yam s — The G azel leH ebdomao

’az

’

r e, ofMarch 8 th

,reports a case of

extraordinary precoc i ty in a girl eight years ofage.She was born fully developed

,and w ith hair on the

pubes, menstruated at four years ofage, and wasseduced and became pregnan t at eight. Thepregnancy resulted in a mole contain ing a wellcharacteriz ed embryo — N . Y. M ed .

_

‘

7 0urual.

30 THE CANADA LANCET.

trol th e contents ofher bladder, the urine constantlydribbling away

,and escaping at th e vagina

,since her

confinement which was on the D ee. 187 5 . The

labor had been very protracted lasti ng over 20

hours.On making a digital examination

,I found

,the

uterus occupying nearly the whole ofthe vagina,

accompanied by vesical tenesmus,the bearing

down efforts causing the cervix to appear at th evulva. The parts were excessively irritable

,pre

senting on physical examination the vulva and

thighs reddened , excoriated , and pruritic covered

by a vesicular eruption , vagin itis abrasion ofthe cervix; vagina covered by urinary concretion sand

_

excessively disagreeable odors arising from herbody. Placing her in the knee e lbow posi tion andintroducing the speculum , I found the fistulousorifice which was somewhat oval in shape

,its long

diameter,about ofan inch

,correspond ing to

the transverse d iameter ofth e pelvis,occupying

the floor ofthe bladder, close to the upper borderofth e trigonum ves icae .Having expla ined to her the nature of her trouble

I advised her to return home and use frequent

ablutions,also frequent inj ections of tepid water

,

occasionally adding suffi cien t carbol ic acid to prevent fetor, and a prope regimen ,

with careful attention to the cond ition of the bowels

,giving her

no hope ofradical cure , '

save by surgical operationand even that might fail.

In pursuance of th is advice,the case was placed

in my hands with a request that the operation should

be performed. Having dec ided on the 1 5 th Julyas the dayfor Operat ing, I ordered castor o i l to begiven the n igh t previous , and a ligh t diet to begiven on the fo llowing morning

,for obvious reasons.

Drs . Bray and Murphy ofChatham ,having been

prev iously notified , were present, and every th ingbeing got arranged the patien t was placed in Sims’posi tion v iz . , lying on the left side, thighs bent at

about right angles with the pelvis , the righ t a l ittlemore flexed than the left, th e l eft arm placed

behind the back , and th e chest brough t nearly flat

down upon the table, and brough t under the in v

fluence ofchloroform . The perineum being drawnwell back , the buttock and labium up as far asposs ible, at the same time press ing the uterus backwi th a spongehold er , and bringing the anterior

_wallofthe vagina, by th e introduction ofa sound in thebladder, well forward in to the field ofvi sion eu

abled us to obtain a fair view ofthe fistula. The ,

parts were well syringed with tepid water. The

edge ofthe fistula was caugh t with a tenaculum,

and with a long handled curved tenotome,a strip

to the extent ofabou t two thirds ofits circumferencewas cut extending from the mucous membrane ofthe bladder to that ofthe vagina

,and well beveled

from the vaginal surface outwards . The remainderwas removed in the same way

,any inequal ities .

being evenly pared offwith the curved scissors,

care being taken to remove the ent ire border,with

sufficien t tissue to insure,as far as possible

,success .

The amount taken measured fully one fourth ofaninch from the edge of fistula to point ofvaginal‘.section; during th is part of the operation the sponge

was used freely to check hemorrhage. Seven

sutures,were now inserted , of smal l siz ed silver wire '

by charging the needles directly with the wire,and

not u s ing the silk as generally recommended. The

firs t attempt was made with the silk but proved a

failure,the wire giving way at the loop

,before

pass ing through the tissues. I would not again

employ the s i lk,but the s i lver suture alone with

Emmett’s short sl ightly curved needles,as in this .

case not one failed to pass through without break

ing. The fistula was completely closed by carefullytwisting the sutures so as not to break them or

strangulate the tissues . They were then cu t offand .

d isposed of in the usual way. The bladder was .

syringed out to remove the accumulation of bloodand the patient carried into bed , when an opiate

was administered,and Sims’ sigmoid catheter in

set ted in to the bladder and left there, a small mug

being placed under the mouth to receive the urine

Directions were given the nurse to see that thecatheter was kept pervious. The vagina was .

syringed out daily w ith tepid water, occasionally '

using a l ittle carbol ic acid. The bowels were keptconstipated by Op ium ; the diet plain but nourish ing .

The patient was kept as quiet as poss ible, un ti l thetwelfth day after the operation

,when the sutures

were carefully removedfOn digital as well as.v isual examination the parts appeared consolidated

as the subsequent h istory ofthe case has proved.

The pat ient go ing about as usual,and using her

own words,would not know from her present con

dition that there had ever been anything wrongwith her. The prolapsus has entirely d isappearedw ith the use ofa pessary.

I must acknowledge my indebtedness to my

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302

I could feel the sharp edge of the stretched muscle,no rounded offedge l ike the natural 08 , the open ingterm inat ing in a sharp angle, l ike a sl i t in the muscular t issue and being about 2% inches in length .

I wai ted impat iently for 2 hours in hopes thatnature would do someth ing

,but the

'

pains n on im

prov ing and the head not com ing down any furtherI appl ied theforceps through the sl it” , the fleshymasses

,wh ich were by th is time greatly enlarged and

protrud ing through the external parts,being rather

i n the way. I t d id n ot requ i re much force to ex

tract the head, but I d istinctly felt someth ing tearing as i t advanced through the sl it”. Del ivery waseas i l y completed the placenta came away at once

,

and there was cons iderable hemorrhage afterwards. Iexam ined an dfound tha t . the sl it had extendedthrough the place where the cerv ix ought to be

,and

as much further as I cared to fol low i t. Hav ingwith difficul ty found someth ing to b ind her w i th

,I

appl ied i t, gave her a dose of ergot and left herqu i te happy

,smok ing a T. F. On enqu iring from

her mother as to what sort of a labour she had las tt ime

,I was told that she was a long t ime bad and

that Dr . O lgiv ie,form l y ofWh i te Gully distr ict,

bu t n ow res iding in Kingston had to be cal led in,

but that she soon got better after he came. I accordingly wrote to Dr. Ogilv ie, and I give h is recollec

t ions of the case .

Dr. Ogilv ie wri tes me Abou t three years ago,

I was in the v icin ity ofMrs. Thompson ’s resi denceand was told she was in labour, but was n ot askedto see her. Judge

,therefore

,of my aston ishment

when a week afterwards,they sent for me to de

l iver her . O n my arrival,Ifound that the pains

had almost, i f n ot ent irel y,ceased but they stated

she had been in strong labour al l week I On ex

aminat ion Ifound the parts in a state of generalslough ,

”and on turn ing my finger round in the us

(wh ich was n ot larger than a penny p iece) the wholeth ing gave way. I made pressure external ly overthe uterus wi th my left hand, andfound that thehead advanced

,and retreated when the pressure

was removed. Appl ied theforceps,and del ivery

was completed w i th ease. Placenta came away soon

after, and recovery went on rap idly. I saw andexam ined her about two months after

,andfound

that the os was d iv ided in to three sections, each

sect ion hanging down in the vagina,and that the

rupture was the ent ire depth of the cerv ix . It is

THE CANADA LANCET.

taken place,otherw ise i t would have been ' imposs i

~

blefor the uterus to have retained afoetus.”I have great pleasure in forwarding to the C AN

ADA LANC ET the above case, and w i l l only add thatI have heard tw ice from the woman and she says

she i s in the best of health . I hope to have an op

portun i ty of mak ing a vaginal exam inat ion someday

,and w il l favour your readers w ith the result of

the next labour ? i f i t i s my m isfortune to be theattendant.Med ical men are thrown on the ir own resources

completely i n th is country,as the d istances they

res idefrom each other ( in my case I am 25 m i lesfrom a brother practi t ioner) precludes, except in a

few d istricts or in the towns, any consul tat ion or

assistance. M idwifery here cons ists in being cal ledin when the pat ient has done al l she can

,or her ’

friends can suggest,so that whenever we are called

we may expect someth ing queer,

”and in th is case

the real izat ion was greater than the expectat ion . I

w ill be glad to send to the CANADA LANC ET a shortaccount of Jamaica and i ts advantages as a residencefor inval ids

,but as I am i n a hurry to catch the

mai l to Amer ica,I must now conclude.

I rema in,yours trul y

,

JAMES JAGER HILLARY.Balaclava

, Jamaica, W . I . ,

January 17 , 1878 .

To the Ed itor ofth e C ANADA LANCET.

S IR,— W i l l you k indly inform me in your next

issue to whatfees a medical w i tness is ent i tled in aC i ty Pol ice Court

,and obl ige

,

Yours truly,

[Med ical w i tnesses stand on the samefoot ing asother w i tnesses in Pol ice Cour ts

,and in cases before

Just ices of the Peace. No fees are allowed them ].ED.

5mm guinea.

TR EATMENT OF BOW-LEGS IN

CHILDR EN .

Dr. Ernst F. Horst read a valuable and interesting paper on the treatmen t ofbow-legs in children ,at the Hospitalfor R uptured and Crippled , giving ,

the results with and w ithout apparatus . He citedthe Opinion ofauthors who advised as well as those:

evi dent that un ion of the ruptured 03 must hav who condemned the use ofinstruments.

-THE C ANADA LANCET.

Sixty cases had been carefully observed,and

these fou rteen received no mechanical aid,whileforty six had appropriate instruments appl ied. Thefourteen cases were under observation from four to

n ine months , and were treated by manipulat ion ofthe limbs and consti tutional treatmen t. In onecase there was improvement, in four no improvement, and in n ine the curve had increased .

In regard to the forty-six cases to which instruments were appl ied, not one of them was found tohave had an increase ofthe curvature

,though in

some there was no improvement . In cases inwhich there was no improvement i t was noticedthat when they abandoned th e use of the braces the

‘

curvature increased . In sixteen ofthe cases theimprovemen t was marked. I t was seen that thegreatest benefit was obtained in those in which thecurvature was greatest The most sat isfactoryresults were found in children between two andthree years ofage. Dr. Horst said that the lengthoft ime i n which he had observed the cases was notsuffi ciently extended to determine definitely whetherapparatus would completely rel ieve the deformitiesin al l cases ; but there could be no doubt oftheirmarked benefi t. In two ofthe cases in wh ich noappar atus was used for a time

,and in which a change

for the worse was taking place,he had appl ied

braces, and after two months’ use a changefor the

better was observable. The cases that were con

s idered cured had worn braces from nine monthsto two years . There was no inj ury

,as might be

suspected , from atrophy due to the pressure of thein struments. I n al l of the cases massage andfriction of th e l imbs were employed twice daily.

N . Y. M eal y our nal.

THE STR ONG ELASTIC BANDAGE .

The treatmen t of varicose and other chron ic ulcersof the leg is so generall y unsati sfactory, that anyn ew method prom is ingfavourable resul ts is to ‘be

hai led wi th del ight.The latest novel ty is the use of the strong elast ic

bandage, w i th whi ch Dr. Henry Martin claims tohave cured over s ix hundred cases w i thout as inglefai lure. The bandage i s of “ pure rubber

,

”

ten and a hal ffeet long,th ree inches w ide

,and

th ickness of number twenty-one S tubs ’ w ire gauge.

The length and breadth may vary w i th the s ize ofthe limb

,but th is i s the most desirable th ickness.

It is appl ied by w ind ing one turn j ust above the

mal leol i, then one around the instep and sole,then

spi rally up the leg to the knee, where i t is fastenedby tapes attached to the end of the bandage for thatpurpose . I f i t is des irable to apply i t as far as thegroin , a bandage e igh teen to twenty feet long wil lbe necessary. At n igh t the bandage i s removedand the u lcer protected by a piece of o iled l inen

,or

some equal ly s imple dress ing. In the morn ing al l

t races ofoi l or cerates must be careful ly removed,asfatty matters tend to injure the rubber

,and the

bandage shoul d be reappl ied before leav ing the bed .

It should be appl ied w i th j ust sufficient snugness toprevent it sl ipp ing down

,and the increase ofblood

in the veins on stand ing w i ll cause i t to become ofthe exact degree of tightness . The bandag e keepsthe leg warm,

moist,and ai r-t ight , condi tions mos tfavorable to granulation an d c icatrizat ion , and in

add i t ion the gentle,even pressure so supports the

d istended and weakened vascular coats as to preventthat venous congest ion sofrequently the cause of themalnutr i t ion ofsk in . For the first one or t woweeks a papular erupt ion appears under the bandagecaused by obstruct ion to the cutaneous folli cles.The bandage i s their best t reatmen t. In non-specificu lcers no other local treatment is necessary. The

circul at ion ofthe l imb is not stopped, but , ow ing tothe support g iven to the vessels

,i sfacil itated thus

there need be n o fear of caus ing oedema of the foot— ou the contrary

,the oedema wh ich so constantly

accompan ies var icose ulcers i s rap idly absorbed.

The occurrence of oedema i nd icates the improper appl ication of the bandage.

The use of th is a pparatus i s n ot confin ed to thetreatment ofu lcers ; inj uries and .d iseases of thej oints

,especially of the knee and ank le, are equall y

benefi ted. In sprains,the strong elast ic bandage

wound around a jo int affords a constantly presentsubstitute

,externall y , for the d isabled l igament.

The constant pressure induces a rapid absorpt ion of_ the exudat ion among the t issues about the seat ofinj ury

,and the gen tle, equable warmth and moi s

ture,wh ich always accompany i ts appl icat ion

,have

a mostfavorable effect in al lev iat ing and preventinginflammat ion . In diseases of the j o ints marked byeffus ion

,the appl icat ion ofthe bandage after aspi ra

t ion,has been fol lowed by complete success. In

these cases the bandage should be appl ied day andn igh tfor s ix to e ight weeks. I ts use is al so recommended i n d isease of bursae mucosae

,oedema

,erys i

pelas,and erythema

,cu taneous affect ions

,and as a

rad ical curefor varicose veins in the lat ter case i ti s supposed to act by causing adhes ion of the wall sof the vessel s, and thei r consequen t obl iterat ion .

ON THE UN ITY or PHTH I S I S - G R ANC HER ,VIRC HOW, AND CHARC OT.— Pulmonary phth isishas always been the obj ect ofnumerous researches,but oflate years practitioners have made new

studies ofi t in al l d irections. At this moment i t isknown that physicians ar e divided in to two schoolsofun icists and dualis ts on the question of phth isis.Those who bel ieve in the un i ty ofconsumptionbel ieve that the different anatom o pathologicalforms of th is disease do not, in any way, detractfrom th e unity ofthese terms

,and that caseous

pneumonia and tubercles are at bottom the same.Those who controvert thi s view consider that there

la b

THE CANADA LANCET.

.are two ways ofbeing consumptive, and that theree xis t two processes which give rise to the disease.caseous pneumonia

,an inflammatory disease, and

tuberculosis,with the tubercle granulation , a

phenomenon qu ite different from inflammation .

Dualists in phth isis,l ike Jaccoud and N iem eyer.

,

&C .,consider that there are phth isical patients and

tubercular pat ients,and

,if this were the case

,

d iagnosis, prognosis, and treatment should be d ifferen t in the matter ofphthisis . Virchow and;Niemeyer have been the lead ers Ofthis school

,

which has so many adherents in England amongthe younger physicians . In Paris

,on the contrary

,

the older physicians,and in London

,Dr. W i lsonFox and many other abl e men , are un icists .

F irstly, i t i s clear enough that there is less difference ofOpinion among the pract i tioners in thepresence ofthe l iving patient than in the d eadhouse ; and _this is the more singular because inmost diseases the d iscussion ceases when the patientd ies and the anatomical less ions are before us .But when th e sick person is al ive dual ists andun icists both call the disease phth isis , treat i t in thesame way, and, alas give the very same prognos is .Volkmann

,in 1 8 7 1 , writes, in the S anznz/nng

Klzn zso/zor Vortm go— “Caseous inflammation

, i n

our t ime,is not more consol ing than the tubercl e

offormer days . ” I t is tr ue, indeed , that puredualists

,pursue their views even to the bedside

,and

allege that i t i s easy enough to distingu ish caseou spneumonia from tubercle. This i s ev idently merelyan exaggeration

,since wel l-educated un ic ists recog

n ise cl early the difference between cases ofphthis is,

whether they become localised or general ised, &c.

The un icist,however

,admi ts that the d ifferences

n oticeable at th e beds ide do not change the natureof the disease

,and

,sp i te ofthe post-mor tem ap

p earances, he alleges that i t i s always phth isis thati s before h im. He points to the number ofcaseswhere granulations and the soc alled caseouspneumonia are found in the same lung. The dual istrepl ies to th is that there are many cases Of consumption where pneumonia alone is found

,and

alleges that there are d ifferent d iseases,since pneu

mon ia and tubercle may be found isolated. Healso says that lesions histologically so d ifferen t

,can

not be ofthe same nature . The pure dualist mak esa great point ofhis treatment

,and maintains that

dual ism has made qui te a revolu tion in the theraputics ofconsumption .

In France,owing to the works ofLaennec , Louis ,

and Andral,and

,perhaps

,too, because clinical

studi es are more attract ive than anatom i cal andlaboratory investigations

,the doctrine ofun ity

prevail s. One authori ty wil l allege that al l th ese

ofthe novel ties proposed . For instance, Dr.Charcot u ses the n ew terms, but is stil l a un icist inphth isis. In Germany

,on the othe r hand, where

cl inical observers are not in general the personswho carry on anatomO -pathological investigationsin the laboratories

,dual ism is in vogue

,and th e

reason is clear enough. The man who merely examines dead-house specimens of phthis is can hardlybe made to bel ieve in the unity ofth e disease. Thenaked-eye d ifferences , too, are corroborated by themicroscopic appearances ofthe d isease

,for i t is

qu ite true that the tubercle granule differs h istologically from the caseous granulation, so that theobserver has the righ t to say that there are twodifferent les ions . But dead-house pathologists havegone further

,and have said these form two different

diseases— two diseases which have nothing in common but mere chance when they are met in . thesame subj ect

,for the one is specific and hered itary

,

wh ilst the other is neither ofthese,but merely a

simple inflammation like pleurisy.Virchow is most particular in h is definition of

tubercle, and , i n his View, the grey semi-transparentgranulation alone is enti tled to the name . Everyth ing el se ought to be cal l ed caseous inflammation .

A tubercular granulation,he says

,or tubercle

,i s a

nodos ity,wh ich is usually rounded

,formed of smal l

cell s pressed together,and presenting at i ts centre

a degenerating z on e,wh i lst at the circumfe1en ce

there IS a z one ofproliferation .— T/ze Doctor .

LAPAR O-ELYTR OTOMY AS A SUESTI

TUTEFO R C/ESAR EAN SECTION.

DR . T. GAILLARD THOMAS read an importantpaper upon the above subj ect

,giving a deta1led re

port ofall the cases in wh ich the operat ion hadbeen performed

,and setting forth the advantages

wh ich i t had over that ofC aesarean sect ion .

The Operation had been performed only onceprior to the date at which Dr. Thomas performed itin 1 8 7 1 , and then by R itgen. I t had been performed upon the l iving woman since that date fi vetimes , three times by Dr. A. J . C . Skene, ofBrooklyn , and twice by himself. Of the five mothers tnr eewere l iving

,and the number ofchildren delivered

l ive wasfour .

The operat ion was simple,and cons isted of mak

ing an incision through the abdom inal wal ls,from

the sp ine ofthe pubes to the anterior superiorspinous process ofthe il ium

,l ifting the peri toneum

making an i ncision through the upper portion ofthe vaginal wall

,tilting the body ofthe u terus over

to the oppos ite side,and then

,through the d ilated

studies on the f01ms ofphth isis sign ify nothing at cerv ix,del ivering the ch i ld by vers ion

,by the for

all, and that the whole novel ty ofthe modern ceps, or by extraction . Delivery was to be effecteddoctri nes is merely in their terminology. O ther by version i n arm presentat i on ; by forceps whenw riters on med 1c1ne accept w ill ingly enough the new the head presented

,and by extraction in breech

anatomical data, al though they l im i t the importance presentation . Hemorrhage was one ofthe th ings

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306 THE CANADA LANC ET.

an apparel which shal l be perfectly comfortable tothe patient , and in which there can be no dangerofpressure upon the nerve and arteries. The sametreatment is equally appl icable to all the complica~t ions ofwhich I have spoken though

,fortunatelyfor the surgeon

,the injures which are suffi cien t to

produce the comminuted form offracture almostalways result fatally.

In all ofthese wrist-j o int fractures i t is importantto give motion early ; and fortunately, in the or

d inary cases , we can do this at about the end ofaweek — Med . Times .

TR EATMENT OF BR ONCHIECTASIS.

Dr. Bardenhewer says (B er/[ner Klim’

sc/ze

that according to Gerhardt,articular

rheumatism may occur in connection with suppurative diseases of mucous membrane s , and inconsequence ofth e absorption of, and bloodpo ison ing by accumulated

,stagnating

,and d ecom

posing purulent efih s ions,as in bronch iectasis

(bronch itis with d ilated bronch i) , diphtheria, gonorrhoea

, pyaemia, dysentery, etc . In confirmation ofth is v iew, two cases were observed in the CologneHospital . Both were well-marked cases ofbronch iectasis , with abundant muco—purulent andvery fetid expectorat ion

,for which both were

treated with inhalation ofa solution of 2 per cent.ofcarbol ic acid. While under this treatment

,and

improving with i t, both were seiz ed with rheumaticinflammation . In the firs t case there was a singleattack ofpa in , and swel l ing ofthe left knee, whichgave way to local applicat ion ofice. In the secondcase, three separate attacks occured in both kness ,presenting all the symptoms of acu te articularrheumatism , and where rel ieved by the internaluse ofsal icyl ic acid. Both cases u ltimately re

covered completely. Gerhardt strongly advocatesmechan ical compression of the thorax in the treatment of th e bronch iectas is

,as removing the stagnat

ing purulent secretion,diminish ing the concom i tan t

fever, and also relieving the rheumatic symptoms .In place ofthis , the above two cases were treatedby carbol ic inhalation— the same treatment

,indeed

,

having been stead ily pursued for about three years inthe Cologne Hosp i tal in al l cases ofbronch iectasis.Cases ofpneumonia

,pleurisy

,mechan ical injuries

ofth e respiratory organs,etc.

,may at different

stages present expectorat ion of abundan t purulentand fet id sputum . The S putum separates on

standing into three d istinct layers (Traube) ; theupper layer is green ish-yellow

,opaque

,and frothy ;

th e m id-dle serous,transparent

,and albuminoid ;

the lower yellow , Opaque, and consist ing ofpusand d etri tis . I t further contains paste-l i ke plugsofa d irty yellowish color

,wh ich are extremely

fetid, and consist of finely granulated detri tus,

mixed w ith larger fat . globules,

. in which are

suspended occasionally (Vi rchow) acicular crystalsofmargaric acid. In presence ofth is kind ofsputum , treatment has the double obj ect ofcounteracting its putrescence and ofreducing its excessivequantity. Arrest ofthe putrescence of the secretionaccumulated in the bronchial tubes is generally followed by diminution ofi ts quantity— s ince theputrid secretion itsel f acts as an i rritant in causingi ts continuous product ion and decomposition

,and'

also in maintaining the accompanying febrile state;The main ind ication , therefore, i s the arrest oftheputrefactive process . The experience ofthirtycases with in the last three years is

,that th is is best

fulfi lled by the inhalation of carbol ic acid .Forth is purpose a solution ofcarbol ic acid in water( 1 or 2 per cent.) should be inhaled every two

hours day and night for several weeks. The resu lthas always been most favorable

,even when

,from

the nature of the case, complete cure was out ofthe question 3 while in several instances , when .

strong evidence ofcavities ex isted,this treatment

led to a perfect restoration to health .—Louo

’ofe

M ed . R ecord,Feb. 1 sth, 1 878.

H/EMOPTYSIS SUBCUTANEOUS IN

JEC TION or ER GOTINE.

Jos. H irschefeld ( VVz'euer P resse,

No . 2 1, says that among the therapeutic

measures used against haemoptysis cold deservessome recognition

,as it

,by reflex act ion

,produces

constriction ofthe vessels and diminution oftheircal ibre, and so facil i tates the formation ofthrombi..The in ternal use ofice is to be preferred to the

external appl ication ofcold . Any therapeuticprocedure against haemoptysis i s essentially aidedby deep inspirat ion (recommended by Niemeyer) ,provided the haemoptysis does not come from a

cavity. The expansive force of air breathed in andheld in the lungs as long as possible exercises

,

ev idently, a pressure on the walls ofthe vesselsand on the gaping wound. The forced inhalat ionof . astringents has not answered expectationStyptics, such as alum ,

l ead,tannin

,chloride of

iron , etc., taken internally effect but l ittl e, and

often d isturb digestion . Of the narcotics, digital i s .deserves special consideration. as it wil l show a

beneficial al though not a rapid action when theheart is excited

,and especially when an uncom

pensated affection ofthe heart is th e cause of the“haemoptys is .The sovereign remedy against haemoptysis is

ergotine, which, as is wel l known , excites the vasoconstrictors . A solution in glycerine i s .

better than a solution in'

water,as after long stand

ing i t shows but littl e sedimen t aud no fungi.After the inj ection th e spot injected becomes verysensitive , with some heat, followed by redness,which disappears in eight or -ten hours. I f the

THE CANADA LANCET.

patien t i s much excited or has much cough the i has long taugh t th is close relationship . Yet evenauthor is accustomed to precede the ergotine in

jection with on e ofmorphia, or to give them bothat once but in different places. In th is way

,the

patien t becomes quiet in mind and body, and theergotine has a better chance to act — B oston M ed .

and S ur gica l_

‘

7 0um al.

SUR GICAL TR EATMENT OF STONE IN

THE BLADDER .

Sir Henry Thompson ’s paper at the last meetingofthe R oyal Medical and Ch irurgical Society, inwhich h e gave the pith and marrow ofhis experiencederived from the treatment offive hundred casesofstone in the bladder ofthe male adul t, i s un iqu ein the h istory of surgery. The profession hasnever before been presented by one man with suchextensive, exact, and laboriously acquired information on the subj ect ofs tone in the bladder. Withbut few exception s

,the author showed to theFellows on Tuesday nigh t every stone he has re

moved, either by l ithotrity or l ithotomy. On thetable was placed a schedule containing al l th eessent ial particulars ofeach case

,with numbers

corresponding to the specimens. Such an arrangement must have required immense care and at

ten tion to deta il,and would have been almost

impossible had not the au thor,as he told h is

audience, methodically made written records ofeach case on the same principle from the commencemen t. So anxious was he to be authentic

,

tha t , he attached to each case the name ofthemedical man who had original charge ofth e patient,or, none such existing, he mentioned the name ofany medical man who happened to be present atthe operation .

Sir Henry’s five hundred cases represent his

entire and unselected work from the commencement ofhis career up to January, 1 87 7

— a periodof n ineteen years. These five hundred cases oc

curred in four hundred and twenty individuals oftwenty years old and upwards , the mean age beingS ixty-one years and a half no women are includedin the series. Four hundred and twenty-two werecases of l ithotrity with a mortal ity ofone in th irteen ,and seventy -eigh t were cases ofl ithotomy with amortal i ty of one in two and three-quarters. Themortal ity ofth e whole five hundred was one in eigh tand a half. So low a rate is a very enviable result

,

and shows how much can be done by a j ud ic iousselection ofth e two Operations. And perhaps nofact was more important than th is , upon wh ich theauthor laid s tress, viz . , that li thotomy and l ithotrityare not to be regarded as antagonistic

,bu t as com

plemen tary the one to the other ; and, so far frombeing opposed to each other, that they are reallyi nseparable companions . Sir Henry Thompson

now,in many minds

,the two procedures present

conflicting claims ; and i t is observable that th isbel ief seemed to characteris e the remarks of someofthe speakers who fol lowed in th e discussion .

This feel ing has to some extent originated in theenthusiasm with which the celebrated father ofl i thotri ty

, C iv iale,very natural ly advocated the

operation . He,i ndeed

,endeavored almost to

supplan t l i thotomy,and .moreover claimed an im

mun i tyfrom al l risk to l ife for his favorite innovation .

Sir Henry Thompson,at the conclus ion of h is

paper strongly urged the prudence ofrestrictingthe application ofl i thotri ty to narrow l imits andstated

,as the result ofour experience: that he

should rarely attempt to crush a hard stone overone inch and a quarter in its largest diameter, orany stone that could n ot be crushed by a flatbladed lithotrite

,utterly condemning th e u se of

the fenestrated variety. AS l ithotrity, confinedwith in due l im i ts

,i s unquestionably a safer Opera

t ion than l ithotomy,i t naturally resul t s that the

early detection ofstone in the bladder should beth e constan t aim ofthe practical surgeon . Theauthor adverted to the occasional ly d istress ingafter-results oflithotri ty, and agreed with Mr. Cadgethat there are some who n either d ie nor recover

,

but continue to suffer wi th painfu l symptoms . Buthe though t these cases would be much more nu

frequen t,if l ithotrity were confined to the l imits

laid down . And he poin ted out that they werecases in which the bladder

,ureters, and kidneys

were diseased prev iously to operation , and inwhich l ithotomy was almost necessarily fatal whils tth e occasional in troduction ofthe l ithotrite afterwards was the price paid for l ife. And he inferred

,

th erefore,that

,when the patien t ul timately suc

cumbed,i t was unfair to attribute h is death to

l ithotrity,when i t might more fairly be said that

the lastfew years ofh is l ife had real ly been gainedby i t .I t is worth remarking that th is report comprises

al l th e au thor’s cases ; and i t therefore, includeshis period of inexperience as wel l as th e results ofhis ripe and mature knowledge. I t is

,therefore

,

poss ible that the surgeons of the future, recognisingthe properrelations between l ithotomy and li thotrity,and the importance ofth e early detection ofcalculus, may even obtain a lower rate of mortali ty,than Sir Henry Thompson ’s resul t of on e in e ightand a hal f ; and so contrib ute, s ti l l further to rendersurgery ( to use th efel icitous language ofSir JamesPaget)

“ a most happy profession .

” M ed.

y our /w ], March 23rd , 18 78.

BoR Ax AND N ITRATE or POTAS S IUM IN S U DDEN HOARS ENES S . These two sal ts have beenemployed with advantage in cases ofhoarseness andaphon ia occurring suddenly from the action of cold

r0

THE CANADA LANCET.

(“ La France Medicale The remedy is recommended to S ingers and orators whose voices sudd enly become lost, but which by th is means can berecovered almost instantly. A li ttle p iece of boraxthe siz e ofa pea is to be slowly d i ssolved in themouth ten m inutes before s inging or speaking theremedy provokes an abundant secretion ofsaliva ,wh ich moistens the mouth and throat . This localaction of borax should be aided by an equal doseofn itrate ofpotassium taken in a warm solutionbefore going to bed . Times .

THE PESSAR Y CATHETER IN THETR EATMENT OF BLADDER AFFECTIONS ;BY REGINALD HARR I S ON , Surgeon to the

Liverpool R oyal Infirmary.

I have recently been u s ing in the local treatment ofth e bladder soluble pessaries

,in troduced

by means ofa Special instrument manufactured forme by Messrs . Krohne and S esemann

,and which

I have designated a pessary-catheter.The instrument consists ofa metall ic catheter,

open at the end,into wh ich is rece ived a cocoanu t

butter pessai y, contain ing the requis ite drug. Afterthe urine has been al lowed to run off

,by press ing

the stylet the pessary is proj ected into the bladder,

when the instrument is at once removed. Thepessaries have been specially prepared for me byMessrs. Symes

,ofHardman-street

,Liverpool

,and

contain various agencies,includ ing morph ia

,opium

,

bismuth , nitrate ofS i lver, perchloride ofiron , andbelladonna. The pessaries are so shaped as toform an endfor the catheter ; and thei r exposedsurface is hardened by a layer ofS permaceti , so asto prevent their becoming d issolved in the irpassage down the urethra . The instrument hasbeen made for me in two s iz es ; in one the endcorresponds with a No. 1 2 bougie

,in the other

w ith NO . 8 . Pessaries to fit each have been madefor me by Messrs . Symes .In several cases of irri table bladder arising from

various causes I have used th is instrument withgreat advantage ; in some cases as an adjunct toother local treatmen t

,such as washing ou t the

bladder, catheterism , &c. The treatment ofmanybladder affections is only to be effectually carriedout by local measures

,and

,in add ition to those we

are already provided with,I believe the instrument

I have now described will be of service. I havecertainly found i t so

,as i t enables the surgeon by

one Operat ion , fi rst ofall , to empty the bladder,and , secondly, to apply what is required , d irectlyto its mucous surface . In th is way

,I havefrequ

ently given a patient a good night by a morphiapessary, where rectum suppositories and othermeans have failed — The Lancet

,Feb . 9th, 1 8 78.

A UNIQUE CASE.

BY DONALD MAC LEAN, M .D. , PROFES S OR OFSURGERYIN THE UN IVERS ITY OFM IC HIGAN .

TREATMENT OFGANGL ION — Bidder, ofMannheim ( C /zl .f. C /l r .

,1 8 7 7 , No. recommends the

inj ect ion of carbol ic acid as a safe and successfulmethod oftreat ing these annoying growths . Theproper procedure is as follows. An ordinary hypo

Mr. and Mrs. W. D . called upon me on theroth June last and handed me a letter from Dr.Allen . of Charlotte, ask ing my atten tion to thecase Oftheir son , cet . t/zreeyear s, who was sufferingfrom a painful swell ing ofthe right upper j aw.

The doctor’s diagnosis,as stated in h is letter, was

abscess ofi be antrum .

On exam ination I found the face much swollenon the affected S ide, the lachrymal duct seriouslyobstructed

,and the skin irritated somewhat by the

flow oftears . On looking into the mon th , whichwas done under chloroform, pus was observed exud ing from the middle ofthe alveolar process inright side. The introduction ofa small probe into th is l i t tl e sinus at once revealed the presence ofa m inute scale-l ike exfol iation , which was easilyremoved by means ofa small dissecting forceps.This done

,I at first supposed that there was

no th ing more to do,and as the parents were ex

trem ely nervous about the anaesthetic I was notunwill ing to believe that the time had come toperm i t a restoration to consciousness

,and so rel ieve

their apprehensions.A moment’s reflection

,however

,induced me to

suspect that the exfoliat ion,wh ich had j ust been

removed,was insuffi cien t to accountfor all the

conditions present,and I therefore insisted upon a

more prolonged exploration . On passing the probein to the open ing in the alveolar margin , i t at lengthappeared to touch someth ing in the antrum , wh ichappeared to be unattched . Accord ingly I used apa i r ofpointed dressing forceps to i ncrease thecalibre and the l ittl e sinuous channel In the alveola,and then I had no diffi culty in seiz ing, and by theexercise ofsome force withdrawing tbc perfectlydeveloped crown ofa permanen t molar toot/z, with al ittl e mass ofglandular structure, which reposed Inthe concave surface from which the fang Shouldnaturally have proj ected.

No other treatment was advised, and somemonths afterwards I saw the l ittl e patien t in goodheal th and much improved as regards the facialdeform ity.

The specimens derived from this case are nowin the possess i on of Prof. Taft ofthe Dental Collegeofth is Univers ity

,by whom they were recently

presented at the meeting ofthe State Dental Associat i on

,the members ofwhich were unanimous

in the op inion that the case is an unprecedentedon e. M ich igan M edical ZVezos .

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THE CANADA LANCET.

had been suppressed,returned . The color gradually

came to her l ips,gums and tongue and she fel t

well ; her appetite was good , her bowels regular,and her headache all gone. She was consideredpractically cured

,although it was thought best to

continue the adm inistration oftwenty drops ofthechloride ofiron , in water, thrice dail y , discontinuing the hypodermic inj ections ofthe dialysedsolution .

~— P/zi ladelb/zia M ed ical Times .

MUR IATE OFCALC IUM IN TUBERC ULOS I S .

This remedy possesses a most wonderful power incontroll ing

,i f not actually curing, many forms of

tubercular d isease. In my experience I have foundno remedy on which so much rel iance can be placedin tuberculosis as on this sal t more especially

,

however,th is remark applies to the wasting diseases

ofchildren . I t has been most extensively used byme during the past four years

,and with the most

gratifying results— having prescribed i t in everyform oftubercular disease that has come before meduring th is period — R OBERT BELL, F. R . C . P.,

inLondon Lancet.Dr. Bell has used i t successfully in pulmonary

c onsumption and in glandular and bone scrofula,as well as in tabes mesenterica and in tuberbular

peritonit is. Dose for adul ts , 20 grs . , more or less,after meals. I t requ ires to be perseveringly used ,and Dr. Bell advises nutrit ion in conjunction withi t the inunction ofOlive o i l i s also recommended .

— Louisville M ed . New s .

CHURC HILL’S T INC TURE OFIOD INE . ByTlzeoplzi lus Pam/ in , M D .

—Church il l ’s tincture ofiodine is so valuable in uterine therapeutics, thatit is to be regretted druggists are not more gene rally fam i l iar with its preparation . It has happened to me within afew weeks to have two pres cription s for th is tincture fi l led

,in on e case , with

the ordinary t incture,in the other w ith the so -cal led

c olorless tinctnre . Even when an em inent teacherin a col lege of pharmacy was appl ied to by anIndianapolis druggistfor the formula for Churchil l’st incture

,he gave on e for a compound ofiodine

.and chloral in alcohol , and also referred to thesolution ofiodine in glycerine advised by Thomas !Thefol lowing is Church ill ’sformula as given in

the fifth edition of h is Diseases ofWomen : hestated then

,1 864, that h e had been using it for

twenty years

R Iodin . pur ., g i iss .

Iod id . potassi, 5 S S .

Spt. rectificat., f xi i.Alcohol

,f 3 iv. Solve.

After employing this t incturefor thirteen years ,I know no S ingle agent in the local treatment ofu terine d isorders at all equal to it. I t may be usedas a stimulant, alterative , counter-irri tant, caustic,and as a hemostatic

,and for the purpose of exciting

absorpt ion of hypertrophied t issue. I ts hemostatic

properties are of especial util ity in the treatmen t ofhemorrhagic endometri tis

,and after the use ofthe'

curette or forceps in the removal ofsmaller intrauterine growths

,hypertrophies of the glandular

and vascular elements of the l ining membrane .Amer ican P racti tioner .

INJUR I ES OFTHE HAND — Professor Verneuil,

C ou r r ier Med ical ) says, when you have to treat apatient suflering from a hand crushed in any waywhatever

,take as an absolute rule to cut away

nothing, to regulate noth ingwith the bistoury. He

gives the reasonsfor th is, first, that parts wh ich i twould appear necessary to cut away

,at first regain

their shape and usefulness and secondly,that

operation s performed two or three months after,

when the parts are in a state ofabsolute calm,give

much better results .

MAL IGNANT SCARLATINA TREATED BY SAL IC YLICAC ID.

— A recent number ofthe B er liner Klin i sc/zeWoc/zensc/zr ift contains an account ofa severe caseofmalignant scarlatina, in the treatment ofwhichsal icylic ac id, given internal ly and inj ected into thenose produced the happiest resul ts. The patien twas a boy, thirteen years of age, who had beensuffering for some weeks from symptoms ofgastroenteritis . On the second day ofthe scarlatinaleruption , diphtheritic patches appeared on thepharynx and nasal cavities

,and on the integumen t

ofthe nose and lips . These were accompan ied byulceration

,and a C opious discharge from the nose

,

w ith a pecul iar fetid odor. The pulse was 1 50

the temperature A grain ofsal icyl ic acidwas administered every hour, and a solution , containing on e grain to the ounce

,was inj ected into

the nasal cavities every two hours. Soup,w ine

,and

eggs were freely given , and the pat ient’s body wasordered to be frequently sponged with cold water.Under th is treatment the symptoms gradually subsided . After the first inj ection the fetid odor beganto disappear. Altoge ther the boy took about n inetygrains of the acid. He was convalescent in thre eweeks. Symptoms ofin testinal catarrh

,apparently

caused by the acid, yeilded read ily to treatment.

MAKING COLD DR INKS .— A convenient ap

paratus for th e s ick-room where cold drinks arewanted is recommended by Les Mondes .” I t ismade by placing two vessels (presumably ofglass) ,on e with in the other

,and fi l l ing the inner vessel

with a solution of nitrate ofammonia. The outervessel may be a goblet

,and the inner one is

formed in the shape ofan inverted- truncated cone,

and has a cover that is large enough to cover thegoblet.For a goblet ofwater 1 50 grammes of then itrate ofammonia are placed in the inner vessel

,

and water is added ti l l i t is fi lled . To hasten theaction, the solution should be stirred as the water

THE CANADA LANCET.

To use the solution again i t is onlyspread i t in the sun till the waterd the n itrate recrystallim s — S cr ibner

UNEQUAL LENGTH or LOWER L1MBS .—The

equal ity in length of the opposite l imbs has h ither

to been but l i ttl e questioned bu t Dr. Jarvis Wight

precision,but I have made enough to satisfy me

that you are correct.”— P roceedi ngs oftbc M ed ical

S ociety ofti le C oun ty ofK ings .

A NEW OPERATIONFOR FRAC TURE OFTHEPATELLA.

— In a case of fracture of the patella atKing’s College Hospital

,Mr . Lister cut down on

the fragment,opening the knee j oint, cleansed th e

surfaces ofthe fragments,and having established

an independen t drain O f horsehairfor th e kneeofBrooklyn , made a series of sixty observations . l lO in t, drilled the tWO portions Ofth e patella andwhich S how that inequal ity ofth e lower l imb is notonly common

,bu t the rule. Dr. Hamil ton ques

tion ed the accuracy ofthese observations in on e ofhis cl inical lectures , and called forth in reply apaper read by Dr. Wight before the Kings CountyMedical Society. In th is paper forty-two addi tionalcases were recorded, giving resul ts very s imilar tothe firs t series. Some interesting measurementswere given

,which tended to show that d ifferences

existed both in the femora and the tibiae,and also

in the humeri,bu t n o extended number of observa

tions have as yet been made in this direction .

Combining these two series ofcases,Dr. Wight

found inequal ity in more than three-quarters ofthenumber

,varying from one-eigh th inch to one inch ,

averaging one-quarter inch . This explains thegreat variation in the amoun t of Shorten ing occurr ing after fracture ofth e femur

,for, if the longer

femur be broken , th e“ natural inequality ” must

be subtracted from the actual Shortening or,if

th e Shorter femur be affected , the natural inequali ty must be added to the actual Shorten ing togive the “ accidental inequal ity ofthe l imbs .This would al so explain those rare cases in whichthe fractured femur is longer than i ts fel low . Thefact that these latter cases are not more commonthan they are

,Dr. Wight explains in the following

manner : The average Shorten ing after fracture isprobably not affected by th e natural inequality

,for

the Shorter l imb is presumably broken as frequently as the longer ; the average shorten ing he placesat five-eighths inch

,and

,ofcourse

,the natural in

equal ity must be greater than th is to give lengthen ing to the fractured femur

,and th is great

inequal ity is so exceptional that he estimates thechanges oflengthen ing as one in two hundredcases. The article concludes with a letter j ust r ece ived from Dr. Hamilton

,from wh ich the fol low

ing is an extract I have done you and science aninj ustice, and I make haste to repair the wrong.

Yesterday I , for the fi rst , found time to verify, byactual observation , th e correctness ofyour statement and that ofDr. W. C . Cox , ofPhiladelph ia

,

that the femora ofmost adul ts are unequal inlength . In a doz en or more measurements

,made

with great care by my house-surgeon and myself,a

large maj ority were found of unequal length , andthe left l imb was generally the longest. I proposeto extend my observations and to give them more

tied the fragments together with s ilver wire, andthen closed the wound

,which was also drained

with horsehair. This operation was performed S ix

weeks ago ; th e wound, as exposed to-day, wasseen to be completely healed

,th e ends of the s i lver

wire proj ecting through the scar. The highesttemperature that had occurred was 1 00

° Fahr. onthe morning after the operation . There has beenno disturbance

,constitu tional or local

,and both

the wounds healed in about a fortnigh t. The l imbwill be kept at res tfor another fortnight, when , ifun ion have taken place

,the wires w il l be wi th

drawn — B r i ti sh Med . y our .

IOD IDE OFETHYL IN ASTHMA — Professor Séehas employed inhalat ions ofthis substance in fivecases ofasthma, and the paroxysm was arrestedin al l very rapidly. In three cases ofcardiac dyspnoea it al so acted favorably and in two cases ofchronic bronch itis accompanied by dyspnoea theeffect

,although much less prompt, was advantage

ous. Quite recently, in a case ofoedematous laryngitis

,inhalations repeated ten or twelve times a day

effected a cure . Like the iodide ofpotassium,the

iodide ofethyl increases the bronchial secretion ,and by th is hyper-secret i t n renders i t more fluid

,

and thu s favors the admiss ion ofair into the pulm onary alveol i .

‘ The iodine S timu lates th e actionofthe respiratory centre, and , by reason ofthegreater quantity of blood th is is brought in to contact with

,respiration becomes more easy, being

still further aided by the ether in combination withthe iodine.The general conclusions to be drawn from the

paper are I . Iodide ofpotass ium constitutes th emost certain means ofcuring asthma, whatever i tsorigin may be. 2 . The iodide ofethyl rel ieves theparoxysms ofasthmatic dyspnoea with great rapidity. I t also appears to act advantageously in cardiac and even in laryngeal dyspnoea.— London

.Medical Times and G az ette.

NEW MODE OFTREATING VAR IC OC ELE .— I find

the following S imple procedure an efficien t methodoftreating varicocele. Pass a long and strong hairl ip p in between the veins and the scrotal walls ,bringing the poin t ofthe pin close beneath , butnot through

,the scrotum then make the poin t re

trace its course,but passing now beh ind the veins

,

I'l of‘

iD

u ,

‘ u

l

I” ,

r

THE CANADA LANCET.

unti l i t emerges near the puncture.

through which it are provided,so that each consumer pays for what

entered. In a word , by employ i ng that form ofhe consumes.I t i s claimed that the system can

acupressure known In the Aberdeen School as the be developed S O as to furnish steam at fifty poundsmethod 0fTetroC IU S iOH , a varicocele may be effecu pressure transmitted through twenty miles of pipe .ally compressed and the vems obl i terated. Dr.BRADLEY

,in B r i t. m ed . y ou rnal.

OPERATIVE TREATMENT OFINTERNAL P ILEs .

Mr. Annandale d iscusses the comparat ive ad ~

vantages ofthe clamp and cautery,and the l igature

in the operation for internal piles,in the Edinburgh

Medical_

‘

7 barual for June , 1 8 7 7 . He claims forthe former the following advantages

1 . By means ofth e clamp and cautery the pilesare at once removed

,and do not remain in the

rectum as dead and putrid masses .2 . The irritation and pain are not so severe or

so prolonged as in the operation by ligature.3 . The patient’s confinement to bed and to the

house is much shorter.4. The resul ting sores heal more qu ickly

,and

are attended with less risk ofsuppuration,and i ts

attendant local and general dangers — M edical

SAW—DUST PADS IN SURGERY.— Dr. Call ender

,

surgeon to St. Bartholomew’s (London Lancet ),September, 1 8 7 7 , has u sed pads made of pine sawdust, in wounds, amputat ion , etc . ,

where there isa discharge of pus . Sawdust from hard woodsdoes not answer, because it absorbs too S lowly.

He first appl ies carbol iz ed l int,then the pad. He

gives a number ofcases to illustrate i ts successfulappl ication

,and pronounces i t “

S imple , in expens ive, and efli cacious .

”— Pacz]‘icM ed . y ournal .

BROWN-sEQU AR D ’

S TREATMENT OFEPILEPSY.R S od i i brom id i

Po tass i i brom id i aa 5 i ij ;Ammonii bromidi

Potass i i

Amm on iae iodid iaa 5 15 5

Amm on iae sesqu icarb 3 jTinct. calumbae fl.§ jssAquae destillat . , ad fig v i ij . M .

Full dose One and a half drachms before everymeal

,and three drachms at bed-t ime.

HEATING A C ITY BY STEAM . The experimentofheating Lockport

,N . Y.

, by steam has proved ,i t is claimed

,h ighly successful . Three m i les of

p ipe properly covered w ith n on-conduct ing materiallaid under ground through some ofthe princ ipalstreets radiate from a central boiler house

,and

fifty d ifferent dwell ings and other edifices,includ ing

one large publ ic school bu ilding,have been

thoroughly warmed all winter. Dwell ings more IT is intended to hold a public celebration of thethan a m i le d istant from the steam generator are completion ofth e fort ieth year ofprofessorship ofheated as read ily as those next door. Steam meters Dr. Schwann

,at Liege

,in the end of June.

TREATMENT OFEFFUS ION INTO THE KNEE-JO INTBY AS PIRATION .

— M . Dieulafoy,after studying the

h istory of1 50 cases, expresses these conclusionsThe evacuation ofeffusions in to the knee-jo int

,by

puncture with the asp irator-needle,i s entirely safe

,

if the operation is properly performed— i . e . ,if th e

diameter of the instrument does no t exceed that ofthe No. 2 needle Infact

,a needle of

th is siz e does no harm . The introduction ofair isimpossible , since the fluid passes from one closedcavi ty, the joint, in to another, the aspirator, inwhich a vacuum exists. I f accidents follow

,they

are to be attribu ted to the employment ofan instrument oflarger S i z e, to unnecessary manipulation ofthe joint , or to use ofthe l imb too soon after thepuncture . Effusions due to external causes

,whether

bloody or not, d isappear generally after one or twoasp irations. Fibro—serou s effusions necessitate amore prolonged treatment and from one to S ix punetures . I t is desirable to apply an elast ic bandageto the j oin t before operating, leaving exposed the

place of puncture. This point is on the outer sideof the patella

,two-th irds ofan inch from its border

,

and on a level with its upper surface. After removal of the fluid

,compress ion Should be made by

means ofa bandage over a layer of cotton . In bu tone of1 50 cases has any accident supervened.

G az . H ebd , 1 8 7 8 , No . 8 .— N . Y.

,M ed . 7 0m m.

INOC ULABILITY OFMAL IGNANT GROWTH S .—NO

vinski ( Inaug . Diss ., S t. , Petersburg 1 8 7 7 ) states the

following conclusions as the result of many exper i

ments on dogs and horses 1 . There is no doubtas to th e pos ib i li ty ofinoculating medullary carcinoma and myxo-sarcoma. I t is accompl ished bymeans ofthe smallest possible incision in the Skin

(5mm long) , and th e insertion offresh port ions ofthe tumor. 2 . The p iece to be inserted Shouldnot exceed two or three m i ll imetres in circumference. 3 . The elements ofcarcinomatous tumorsact probably as infecting agents when thus placedIn the heal thy tissues. 4 . The conditions essentialto the success ofthe experimen t are the selectionofanimals of the same S pec ies, and tissues of thesame sort as those in which the growths exists .

5 . Fatty degeneration is more active in the inoculated growths than in the “mother—tumors .” 6 . Inall successful inoculat ions the wound healed by firs tIntention

,but suppuration ensued on the degenera

tion ofthe inoculated portion .— C en tr alblattfur

C /zi rurgi e, No . 1 2,1 8 7 7 . W. T. B .

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THE CANADA

exceptions,to Show how great an inj ury the brain

may sustain without permanent damage,and yet

no organ is more sensitive or requiresmore del icatecare and treatment. The surgeon ’s motto in treat

ing brain injuries may safely be n i l desp erandum,

whil e in view ofthe rel ief to idiotcy recently reportedin this journal , as the resul t ofrel ief ofpressure bythe operation of treph in ing

,we may wisely wait

the development ofevents,to Show what surgical

skill or human device can accomplish,for the im

provemen t of defective brain conditions and the

rel ief ofbrain inj uries,before asking the question,

what next P

NEW INSTR UMENTS AND APPLIANCES.

We have received the quarterly report of

Messrs . Burgoyne, Burbidge 8: C O .,London

,Eng.

Of a l ist ofnovelties and special ties,among the

most prominently useful for country practitioners,

we notice a new pocket Magneto-electric machine,

enclosed in a smal l mahogany case,five inches

l ong by three inches wide,admirably adapted for

carrying in the pocket . In intens ity i t is equal tomachines four times i ts S iz e

,and in working

,noise

less. Price 2 1 shill ings . A new speculum vaginte ,

the novel ty ofwhich is in the economy ofspace,

by arranging for the supply of a number of instrumen ts

, in constant request by the obstetri cian ,Without any increase in the bulk of th e speculum .

The speculum consists of two tapered metal tubes ,highly polished for reflection

,fitt ing the one with in

the other, and capable of being used independently,thus forming two specula of consecu tive siz es.Both have a lateral opening; the inner one may byrotation close that ofthe other Wholly or in part,so that any desired surface ofthe vaginal walls canbe exposed for in spection or operation. The plug

fi ts accurately the inner S peculum,and has i ts end

coned to fac il i tate introduction . I t is closed at i tslarger extremity by a movable metal cap

,which

serves as a reflector for a candle lamp . The com

plete S peculum is enclosed in al eather case, andoccupies with thefollowing instruments no moreSpace than an ordinary Ferguson's speculum

,v iz .;

Simpson ’s sound, u n i ted by a screw or hinge j ointto a fenestrated elevator ;port caustique ; lancet, andSponge holder, each fi tting into a porcupine quill

handle ofsuitable length ; candle lamp and re

LANCET.

POST MOR TEM EXAMINATIONS .

cutaneous syringe , set in aluminium with caps andbott les. Dr. Batten’s urinary test case

,supplied

by th is firm for th irty Shillings , is thus noticed in the

London Lancet, for December, 1 87 7 . s

We have no hesitation in bringing Dr. Batten ’s ,very ingenious invention before our readers. I t

seems to fulfil a real want and an actual in spection ofthe apparatus has shown us how large anamount ofcare and thought has been bestowedboth by the inventor and manufacturers

, on the

perfection of th is addition to the armamentarium,

which th e busy practitioner finds i t necessary to

stow in h is pockets or in h is carriage. Dr. Batten ’simprovement consists in an aluminium case about

four inches long and half an inch in diameter, re

sembling in appearance the ordinary pocket caustic

holder, and S imilarly divided into two compart

ments. The smaller compartment has with in i t,

th ree vulcanite specific gravity beads,marking the

extreme and mean Specific gravity of urine. The

larger compartment contains a test tube,within

which are three or four capillary tubes,hermetically

sealed,charged with nitri c acid

,and a bottl e for

Fehl ing’s test solution . Th is bottle is closed withan india rubber stopper

,upon which the alkal i has

no action,and hence the copper solution wil l keep

good and clear in it,as long as may be required.

The screw j unction unItIng the two parts of the

case is itsel f hol low,and holds excluded from the

air the red and blue l itmus paper. A wine glass

and a candle or lamp which can always be obtained

are all that can be further required. The specific

gravity beads will be found to tel l the specific

gravity accurately, whilst they have the advantage

over the urinometer,that a very small quantity of

urine will be sufli cient for the purpose.

A case lately occurred in th is ci ty,in wh ich ,

owing to the perfunctory manner in which the

post mortem examination was conducted , and

wh ich we fear is too often the case, almost lead tothe casting ofan unmerited slur, upon , so far aswe know

,a respectable young man . We allude to

th e cas e ofMr. Shea,whofell down a flight of un

protected stairs in a dark night, and was afterwards

THE CANADA LANCET.

that in vomiting suffocaom the pas sage ofth elarynx and trachea, andn accordance with th is

h e undertaker in placing the body in

however, discovered that the n eck was

than usual , and said that he though tneck was broken . This was comto th e coroner, who

,immed iately

e body to be exhumed and anotherbe made, when i t was d iscovered that

th is case with any desire tontlemen who performed the

what i s too commonly done

ations, rested sat isfied when

will we hope,not

effec t ofmakingmedical men more care ful and thorough in thei r

death , both thethe publ ic will be the gainers.

TOR ONTO MEDICAL SOCIETY.

e firs t regular meeting was held on the 16th

Dr. Workman , as president opened the pro

To

and there are but few members

the Dominion who do not,a

tion would appear unnecessary,

ny , who in a very long series of

shed themselves more’ honour

dvancemen t ofmedical science,

heart ofthe au thor,and gave unbounded satisfac

tion to th e body to whom i t was addressed as worthyofh is reputation as an accomplished writer. The

doctor alluded to the gratifying fact of the Societyincluding in its rank s , many young members ofth eprofession Who gave earnest ofa successfu l futureWho were not converts to th e doctrine , that a man

’s

success as a practit ioner is often in an inverse ratio

to h is scientific attainments that scientific know

l edge is not incompatible with practical Skill , and

the speedy acquirement of a lucrative practice,not the only aim of those entering the profession .

ficti ons offin ishes.TORONTO MED IC AL S OC I ETY.

F IRST REGULAR MBETING.

THE PRES IDENT’S INAUGURAL ADDRES S .

G en tlemen ; —That youth has its many embarrassments and d iffi culties to struggle again st is, or has

fw

An adj ou rned meeting ofth e above society washeld in the Canadian Institu te on the 4th ul t. , Dr.Joseph Workman in the chair, and Dr . J . E.

Graham,secretary

, p ro. tem . After th e disposal ofsome routine business the proposed Consti tu tion

and By-laws” were read and approved of, subj ect to

one or two amendments . The consti tu tion shows

that the obj ects ofth e Society are as follows —Forthe discussion ofpurely scientific subj ects connected with the profession ; for th e reading and

discu ssion ofpapers ;for th e relation of cases inpractice

,and for the exhibition of pathological

S pecimens. Under th e By-laws i t i s Shown in ter

al ia ( 1 ) that seven members Shal l form a quorum

( 2) that the annual subscription shal l be(3 ) that the Society Shal l have power to expel any

member found gu il ty ofunprofessional conduct ;(4) that the Society meet every al ternate Thursday.

The Secretary in timated that between forty and

fi fty gentl emen had already joined . The meeting

then proceeded to th e election of officers , when th efollowing Were elected by ballot z— President, Dr.Workman ; I st Vice-President, Dr. Canniff ; z ud

Vice-Presiden t,Dr. C overn ton R ecording Sec

retary, Dr. J . E . Graham ;Corresponding Secretary,Dr. Cameron Treasurer, Dr. Macfarlane Council

lors,Dr. G eorge Wrigh t, Dr. Ful ton , and Dr. Burn s.

TIIE CANADA LANCET.

been . I doubt not, th e discipl inary experience ofall whom I now have the honour ofaddressing ;but that old age brings to its subject its ownp eculair heavy penal ties, i s a stern fact ofth ereal ity of which very few who have , l ike mysel f,considerably exceeded th e scriptural al lotment ofhuman l ife , are permitted to be ignoran t. Amongthe many perplexities, incident to senil e decadence ,few can be more distracting than that which is toooften devolved upon it, by the d iffidence, or the il lcons idered deference ofvigorous juvenility.

Whilst, gentlemen , not only fully sen sible oftheh onou r conferred up on me, by your nomination ofme to the offi ce ofFirs t-President of you r Society

,

but al so heartily grateful for th is manifestation ofyour kind regard , I cannot evad e the convictionthat you have placed me in a position which wouldhave been more fitly, and more efficientl y occupiedby some one of less advanced years

,possessing

,as

I know many of you do , superior scien tific andl iterary qual ifications ; but, as I have already said ,old age brings to its subject i ts allotted penalties

,

which i t may be better to bear with submissiveequanimity, than bootlessly strive to escape ; Itherefore have deemed it my prudent duty

,humbly

to bow to the d ecision of your high court,and to

accept, with all becoming d ifli dence , the hazardousresponsibil ities involved in the umpirage ofyourfuture proceedings , anxiously, at the same time,hoping that you will al l make generous and

charitable allowancefor those errors or mistakesinto which , as a member of the m edical profession ,for so many years monastically i solatedfrom thegeneral faculty, and devoted to a S pecial ty

,th e

dut ies and study ofwh ich left me very l i ttl e t imefor other mental work

,I must inevitably too often

fall. Of one encouragingfact , however, I feelabundantly assured, and that is , that whatever maybe my short-comings, you will do me the ju stice ofascribing them , never to my heart, but always tothe infirm i ties , or, ifyou so please, to the vanitiesofmy headNever, in my long professional career, have I

hailed any event with more heartfel t pleasure,than

the announcement made to me,afew weeks ago

,

by an esteemed professional brother,that a number

ofenergetic and talented young practitioners hadresolved upon the endeavour oforganiz ing aMed ical Society in th is city

,which I may very

safely designate the l i terary Athens of Canada,and

,

perhap s not unjustly,th e metm polis of medical

educauon .

It had very long been to me a matter of deepregret, i f not ofmortifying astonishment, that ac ity so large and wealthy as Toronto

,and embrac

ing in its energetic and intelligent population,an

array of medical practitioners and professors , po ssessing qual ification s not surpassed by those of anys imilar body in Canada

,or perhaps on th is contin

effectual efl'orts were made by a few z ealous gentlemen of the profession to organiz e and perpetuatesocieties similar to that which we now venture tolaunch into existence. I had the privilege ofbeinga pecuniary subscriberfor several years to the oldestone. Though i t l ived but a few y ears , i t d ied literally and unequivocally from old age, for i t numbered in its membership but a very meagre percentage ofyoung men . Of the las t defunct conception I know almost nothing. We have

,how

ever, been informed by Dr. R iddel thastarvation , and we are bound to accept as canonicalthe dictum ofthe coroner

,yet I wish he had told us

whether h e held an inquest on th e defunct , so asto be able to inform us of the verdict ofth e jury,based on th e post-mor tem revelations Of the organsofal imentation . I have a strong suspicion that thegal l bladd er was in a very abnormal state, and thatthe poor th ing fell a victim to S lopmilk and colloqu iald iarrhoea ; and therefore would I most earnestlyurge upon our present infant organization the vitalexped iency ofshunn ing these fearful factors ofmortal ity. Give your new-born creature good puremilk, save i t from windy-colic, and keep it out ofthe arms of old wiz ened crones

,whose low tem

perature and senile foul breath , would be sure topoison and freez e its young blood

,and sooner or

later (not, indeed , i t should be hoped , very late,for marasmus is a most pitiable malady) , send it toits grave.You

, gentlemen , must depend mainly on yourown youthful vigorous efforts , for the successfulworking ofyour society. If through timidi ty , overweening modesty

,or

,pardon the soft impeachment,

cul tivated indolence, y ou stand backfrom the work ,trusting to the contributions of your older brethren ,you wil l be doomed to weep over the demise ofyour neglected darling.

Let none hold back because he th inks he hasbut l ittl e to offer

,or th inks his l ittl e too insignificant

to deserve attention . The mite ofthe poor widow,

who cast into the treasury all that She had, even al lh er l iving

,was valued in Heaven ’s C hancery as

greater than all that was paid in by the rich. I tmust be a very poor fact indeed , in medical science ,that wil l be h eld as ofno value by enl ightened andhonourable members ofour profession. Nothingis , to great and penetrating minds, S O l i ttle as toprove unsuggestive ofgreat inferences. To themind ofa Newton

,a Harvey

,a Jenner, a Huntley, or

a Tyndal , no fact, however trivial or commonplace,was ever so mean

,asn ot to evoke serious and pro

lific reflection . Sneering was an indulgence fartoo extravagen t for these hard-working, deep-see ingmen.

Many ofour long experienced friends, whose coen t

, should yet be unable to pride itsel f on the ex operation would be most welcome, and m ight be

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THE CANADA LANCET.

existing societies on th is point, and take such

other action as they may deem exp edien t to that

end.

scholarsh ip

The candidaProf. R obertson . The honor men were

,Messrs

McDiarm id , Chappel , Duck , Parke, Thuresson ,and Welford. Prof. Kennedy presented the scholar

sh ip in th is year to McDiarm id ($6o) and certificatesof honor to the other gentlemen above mentioned.

Prof. Fulton presented the following gentlemenfor the diploma and fellowship degree

,v i z . ,

Messrs

Ashby,Baines

,Bonnar

,Dafoe, DeLom , Dunfield,

Groves,R ankin

,S heard , S tan ley, and D . H .Wilson ,

Glasgow,W. F. G. Grant

,M . F . Gilmour

, J . H. The gentlemen subscribed to their profession and

G ard iner, J. W. Groves, E. A. Gravely, F. V. S. rece ived their d iplomas. Certificates OfhonorGreenwood

,V. D . Graham , J . C . Hartman, F. M. were presented to Messrs Dunfi eld

,G roves

, R ankin,Howe, J . B . Howell, T. C . St. V. Hutch inson

, J . and Stanley, by Prof. Temple. The “ medical

R . Jones, D . Jam ieson, G . A. Kennedy, W. B . faculty” gold medal,was presented to Mr. Sheard

Kennedy, P. C . K idd, G. B . Kirke, O . Langlois,by Dr. C ann ifi

'

; and the“ med ical facul ty s ilver

M. C . Langstaff, W. Lehman , J. H . Lowe,P. medal to Mr. D. H . Wilson

,by Prof. Coventon .

COLLEGE OFPHYS IC IANS AND SURGEON’S OFONTAR IO .

— The following gen tlemen have receivedthe Diploma and License Ofth is bodyJ . Adair, J . Algie, T. H . Ashby, A. M . Baines

,

H . Bennett, Wm . H . Bentley, J . D. Bonnar, F.

Burt, J . D . Cameron,A. D . Campbell

,C . V.

C lark, G. Clinton, S . A. Cornell, W. Cornell,H .

A. Cra ig;W. A . Dafoe,H . A. deLom

,W. A. Dou

pe, F. J. Duggan, J . Dunfield , H . A . Evans,D .

W. Faulkner, J. M. Forbes, J . B. Fraser. S. H .

Lynch,F. W. Lewis, J . MacArthur, H . Meek

, J .

Morrison,T. M illman , F. M. Mills, D . C. McC ar

thy,M . McC rimmon , J . M . McC ort

, G. R . Mc

Donagh , J . McG rath, W. McKay, A. McKelvey,

J . McLellan , J . M . Nei lson , A. Ogg, J . R , Pom

eroy,R . A. Pyne, J . P. R ankin , G. R iddall

, J . W

R oss, W. T. R obson, A . R obinson, R . R eddick,C .

S hupe, C . Sheard, M . Stalker, U . M. Stanley, D

F. S mith, J . Vanderberg, A. Wilson,D . H . Wil

son— Total 79. Of these 33 were from Trin ity Medical School, 22 from the Toronto SchoolofMedicine ,and the balance from Montreal and Kingston. Ofthe 33 from Trinity Med ical School , 30 passed without an oral examinat ion . The exclamation ofAber'n ethy to h is clas s , is not inappropriate hereGod bless you, gentlemen ! What is to become

ofyou all There were 3 20 students up before

the Board,for examination in the different years .

We do not envy the exam iners, bu t rather sympathiz e with them the ir task is anyth ing but lightThe R egistrar, Dr. Pyne, has also been overworkedduring the past month . He has, however, we

are happy to say , discharged h is most onerousduties to the satisfaction ofall concerned.

TR IN ITY MED IC AL SC HOOL — The annual meet

Prof. Geikie presented the “ Trinity” gold medal

to Mr. Dafoe, and Prof. Bethune the Trinity”

silver medal,to Mr. Bonnar. These medals are

the highest honors in th e school , and were given tothe two students standing first and second resp ec

tively in al l the branches, primary andfmal.UN IVERS ITY OFTORONTO MED ICAL EXAM INA

TIONs .— Honors . —The following are the names of

the honor menStarr gold medal

, J . D . Bonnar, Trin ity MedicalSchool. First Starr silver medal , H . Meek, Trinity

Medical School . Second Starr si lver medal , Griffin,Toronto Med ical School.University gold medal

,Griffin

,Toronto Medical

School . F irs t Un iversity s i lver medal,Meek

,

Trinity Medical School. Second Universi ty s i lvermedal

,Bonnar

,Trinity Medical School . Third

University silver medal,Kennedy, Toronto Medical

Schoo l. Fourth Univers ity s ilvera

medal , Gardner,

Toronto Med ical School .SC HOLARSHIPS .

—3rd year

,Burt and year

,

Cross, I s t year, Duncan Ham i l l. Third year’s

exam ination ; Messrs Burt and Sheard. Secondyear ;Messrs Anderson , Cross, Chappell , Fish er,.Hoig, Meldrum, McDiarm id , Spencer and Welford.

First year ; Messrs Aik ins, B ingham , J . C. Burt,ing for the conferring Of d iplomas, etc. and the Duncan

,Ferguson , Ham i ll, How i tt, Haken , Milne,

awarding ofmedals. scholarsh ips and certificates ofSweetman , S impson , Thompson, Tracey, and Wilhonor

,took place in the college bu ildings Spruce st. C OX

THE CANADA LANCET.

PR IMARY EXAMINATION — Messrs Ames, Ander A . Dafoe. These honors are awarded to those

h ighes t in al l the branches . Cert ificates in final

branches— W. McKay, W. Cornell , W. R . Doupe ,ksou

,Duck

,G lend in ing, Gould, Green , J . W. Groves, D . H . Wilson , J . McG rath

, J .Head , Hyde, Kidd , . Leslie, Lindsay, Henderson , C . Sh eard, U . M . Stanley, J . R ankin

,

Cklin, Mackid,Martin

,Montgomery, J . Algie. Certificates in primary branches— G . S

MacFadden , McKinnon , MacLean, Armstrong, W. W. Boyce,W. B . Duck.

Nelles,Nicholson

, O’

R ielly, Park,

those who presented themselves for the primary

ination ,fourfeen were rej ected, ten ofwhomfrom the Toronto school ofmedicine andfourTrinity medical school .FO R THE DEGREE OFM.E.

—Messrs Adair, Algie,Ashby

,Bonnar, Baines, Bentley, Burton , Clarke,

W. Cornell, S. A . Cornell, Dafoe, DeLom ,Duggan

,

Doupe,Gardiner

,Glasgow, Griffin , Groves, Hart

man , Jamieson , Jones, Kennedy, Langstaff, McCarthy, McG rath, Meek, McKay, Ogg , Pomeroy,Pyne, R ankin , R obson , R obinson, R oss, Stanley,S talker, A. Wilson, H . Wilson , Vanderburg.

—39 .

N in teen were from Trinity medical school , and

twenty from the Toron to school ofmedicine,six

were rej ected in th is examination ,fi ve: from eachschooLFO R THE DEGREE OFM.D .

—R . H . R obinson

PR IMARY EXAM INATION R OYAL COLLEGE or

SURGEON S,ENG — W. C . Win skell

,MB . and A.

Davidson,M.B. graduates ofTrinity College

,have

successfully passed the primary examination ofth eR oyal College Of surgeons, Eng.

UN IVERS ITY OFTR IN ITY COLLEGE CONVOCATION .

—'

l‘

he following gentlemen received their

degrees,and standing in Trin ity College

, on the

20 th ult

M .D .— R . J . McKinnon , D. A. Stewart

,A. H .

Miller,F. M . Strangways, D . W. Mitchell

,S.

McArton .

M .B .-H . Meek, J . D. Bonnar

,W. A . Dafoe

, J .

Hartman,W. McKay, W. Cornell , W. H . Doupe

,

J. W. Groves, H . Wilson , J . McG rath, J .

Henderson,C . Sheard , U . M . Stanley, J . R ankin

,

J . Algie, J . Forbes , J . Dunfield, D . Brook

,S . A.

Cornell, A. W i lson,T. H . Ashby

,A. McKelvey,

H . A. DeLom,D . L. McC ort, A. Baines

, J . E.

Morrison,M . Stalker, A . Davidson .

PR IMAR l ES .—G . S. Armstrong, W. W. Boyce,

W. B. Duck, T. A . Kidd. C . M . Thuresson,E. S .

Wil son , T. J . Park, E. Prouse.

HONOR LIST — University gold medal , H . Meek ; TALKING MAC H INE — Mr. Edison is at presen t

s ilver J . D . Bonnar certifi cate ofhonour,W. exh ibiting h is wonderful invention , the phonograph

PER S ONALs .— Dr. R eginald Harrison , F.R .C .S

Eng. surgeon to the Liverpool R oyal Infirmary,

paid a short vis i t to Toronto, a few weeks ago. He

visited the Toronto General Hospital, and paid a

high complimen t to the managemen t ofthat iastitution , and expressed some surp i ise to find such

a well appointed hospital in Canada. He alsovisited Montreal and other places in Canada. An

article by him on the pessary-catheter,Copiedfrom

the London Lamet,wil l be found in another page.

Dr. Cameron , formerly house surgeon Montreal

Hospital, has returned from an extended visi t to

thehospitals ofth e old world, and in tends commencing practice in Montreal.

MONTREAL MED ICAL L IC ENS E CAS E — It ap

pears we were in error,in stating in our last i ssue :

that the Medical License case was settled. Fromthe report ofthe president ofthe College ofPhysicians and Surgeons of Quebec, del ivered to

the Board ofGovernors, at th eir recent meeting inMontreal

,on the oth ult. , we find that

“ the case

came before the Grand Jury in due C ou rse,but the

crown prosecutor having failed to summon thenecessary witnesses, the Grand Jury made a pre

sen tmen t to the court ofignoramus This

presentment leaves the case precisely where i t was

after the action Ofthe pol ice magistrate,and

unless your pres ident is otherwise instructed at th is

meeting i t wil l be again submitted to the Grand

J ury at the next term Of Queen ’s Bench,when

measures will be taken to ensure the attendance ofthe requis ite witn esses .” The Presiden t’s reportshows that the case is stil l in abeyance.

THE CANADA LANCET.

in this C i ty. I t is very simple in its construction ,consisting ofa vibrating plate, a sheet oftin foil,and a crank . This machine which is as simple as a

coffee-m i l l hears a speech or a song, wh ile the

crank is turned in one direction, and by reversing

it the machine talks, sings, laughs , wh istles orcoughs so naturally that one can hardly escape the

suspicion that there is some ventriloquist hocus

pocus about it, or some one concealed near by,

giving utterance to the sounds.

fixed on the tin fo i l by the vibrating plate and arestored up until the instrument i s reversed , when

they are given out with surprising fidel i ty.THE CALEDON IA SPR INGS — This favor ite resort

for inval ids and pleasure seekers is aga in about tobe Opened for the season. These sulphur springs

ofthe Lower O ttawa, have been long andfavorably ,

known for their effi cacy in the treatment of

cu taneous, rheumatic and other chronic affections.The large hotel in connect ion with the springs willbe open from June to October. The accomodationi s all that can be desired , and many who have beenbenefited by a short residence here will be glad ofthe opportunity to again avail themselves ofi tsadvantages.

M I C HIGAN STATE MED IC AL SOC I ETY. -The fol

lowing resolution to amend the consti tution , whichhas been before this med ical soc iety 5 nce 1 8 7 6 and

has been the occasion of much angry d i scuss ion ,was defeated by a vote of 42 to 6 1 , at the meeting

at Lansing on the i 6th ul t., viz ;“ That no person

shall be admitted to membersh ip who practices or

professes to practice in accordance with any so

called pathy or sectarian school ofmedicine, or

who has recently graduated from a medical school

whose professors teach,or assist in teaching, those

who propose to graduate in or practice irregularmedicine.” The amendment consists in the ad

dition ofthe last C lause, commencing with the wordsor who has

,

” etc.,and was chiefly intended as an

indirect censure upon the med ical faculty oftheAnn Arbor University for i ts relations with

homoeopathy.

R ES IG NATIONs.—Dr. Trenholme

,has resigned

his position as professor of Obstetrics in BishopsCol lege, Montreal; and Dr. Fuller, who is about toremove to Grand R apids

,has resigned the Chair

ofanatomy. We have not yet heard who theirsuccessors are.

The sounds are il be held i n Bufi

'

alo N . Y., on th e 4th of June .

that in h is opin ion the best remedyfor cholerainfantum

,or summer complain t in children

,is

calcined radix rhei . He gives it in doses of5grains. I t i s prepared by putting the root in an iron

vessel,and burning i t until eas ily pulve i iz ed .

AMER IC AN MED ICAL AS S OC IATION — The annual

meeting ofthe American Medica l Association willA

large attendance is expected; we trust many o'four

medical friends wil l avail themselves ofthe op

portun ity thus afforded ofattending this meeting.

CHLORAL HYDRATEFOR R EMOVAL '

OEWARTS .

Dr . Craig of Montreal recommends a twenty grainsolu tion ofC hloral hydratefor the painless re?moval ofwarts.FI ELDFOR M IL ITARY SURGERY. -Montreal

would seem to be a most excellen t field for

military surgery, as there have been So many cas es .

of shooting in the streets at nigh t.

MEDI C AL COUNC IL OFONTAR IO.-The annual

meeting ofthe Ontario medical council wil l C ommence on Tuesday the n th inst.

APPO INTMENT.— The professors ofth e CollegeOf France have recommended Dr. Brown-Sequardfor the C hair ofPhysiology made vacant by thedeath ofClaude Bernard.

MR . ERASMUS WILS ON, has resigned theProfessorship ofDermatology wh ich he so generous ly founded at the College of Surgeons. I t isprobable that Mr. Jonathan Hutchinson will succeed h im in the chai r.

CORONER —J. Adams,M .D. , ofThorold ,t o be anassociate coroner for the Co. Welland .

flirtin g &ttatri itgts, grants.

In Toronto on the 25 th ofApril, G eo. M .Farewell , M .D .,C .M . , ofQueensville, Ont. , to

Hannah B. , daughter ofthe late Joseph Wilson ,Esq.

,Duffm’s Creek.

In Toron to , on the 4th ul t. , Dr. Thomas Henry,aged 70 years.

In Streetsvill e on the 1 9th ul t. , Chas. A. Paterson ,M .D .

,in the 29th year Of his age.

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322 THE CANADA LANCET.

wear one wi th any comfort or safety. The testicle

was all wasted , and consequen tly incapable offunctional activi ty

,and its loss would not render

h im impotent . According to the opinion ofth ebest and latest au thori ties

,undescended testicles

were especially prone to cancer,and although its

removal would be attended perhaps with danger,

still,taking everyth ing into C onsideration

,th e

wisest course for him was to take the risk and haveit removed. After hearing and considering these

several reasons he consented.

The Operation was performed on the i 8th OfMarch . I was assisted by Drs. Niven and Harper

,of

thi s city the latter administered the chloroform . The

testicle lay in the inguinal canal,opposite the exter

nal ring, and was about the siz e ofa smal l marble .Alongs ide i ts inner border, and firmly attached to

i t,was a thick piece of tissue

,very similar to a

piece ofin testine ; this had to be very carefullyseparated from the testicl e aud its coverings , before

the cord could be made out an d secured . When

this was done it was cu t across,the usual precau

t ions being first adopted,and tied en masse. The

tissue, when examined, was found to be the sac ofthe hernia in a thickened condition ; a ligature

was necessary on the cut portion ofi t,on account

oftroublesome hemorrhage . When the testicl ewas removed

,

'

the vaginal sac came very plainlyinto view, and a broad director could easily bepassed up as far as the internal ring

,where it was

stopped. The wound was stitched up with silverwire sutures , and a compress of l in t soaked incarbol ic o il

,I to 1 6 laid over i t

,and the whole

enclosed in a spica bandage .

In two hours a good deal ofsecondary hemor

rhage occurred, which was arrested only after an

enlargement of the incision upwards,so as to get

at the cord which had retracted up the canal,in

order to apply a second l igature above the first.This effectually stopped the hemorrhage . Cold

iced-water was then appl ied over the wound,wh ich

was not resti tched. He was then given some

brandy and beef tea, as he was very weak, and atnight pul . op i i gr. j . was ordered.

1 9th. Had a tolerable n ight ; pulse, 1 00 nosickness considerable tenderness and tumefactionover the part ; no hemorrhage ; abdomen above

Pouparts l igament al l right. Cold water dressing tobe continued. Ordered pul. opi i gr. i . , calomel gr. i .every four hours ; low gruel diet, and to be kept

very quiet.

20th.

coated ; bowels not yeswell ing not so great ;Poupart’s l igament ; no

tinue treatment.z r st. Much the same ;

spongio-p iline dippedfor cold water dressing bowels stil l confinednausea. Pul . cal . et op i i every «six hours.

2 2nd . Had a good n ight ; pulse, 94 ; wounddischarging well ; spongio-pil ine too heavy ; l intand Oiled silk was substituted . An enema ofgruel

,sal t

,and castor oil was adm inistered in the

morning,and

,al though repeated in th e m iddle of

the day,had no eflect. He was then ordered two

pills ofpil. col. et hydrarg. at bedtime, to befollowed by a dose ofcastor o il i n the morning if

necessary. Abdomen is soft ; vo ids urine well

Omit pul . cal . et Op i i .23rd . Bowel s open ed this morning withou t Oil

pulse,80 ; wound discharging well , and swel l ing

much reduced : considerable fetor ; all danger ofperitonitis over. Lot ion ofpermanganate ofpot.ash

,grs. v . ad. § i to be applied .

e4th . I s better th is morning ; pulse, 80 ; had

several passages from the bowels yesterday. Pul .

op i i gr. i . to be taken .

a5th. Same cataplasm ofl inseed meal to be appl ied no passage from the bowels tod ay.

a6th. Same ; had a good motion this morn ing ;

feels much better ; wound granulating ; no fetor..

a7 th— a8th . Improving ; wound contracti ng

bowels Open every day continue lotion .

3oth. Much the same ; if the ligatures wereaway the wound would soon heal.

April sth . Ligatures came away on the 3rd ins t.,the sixteenth day after the operation , and the

wound healed in a few days.

Kamarka— There are many points ofin terestin this case. First, it is to be noticed that thehernia was not congenital— not having been dis

covered until h e was four years ofage. Had it

been congen i tal,th e vaginal would then have been

th e hern ia] sac,a contingency wh ich would have

been so much the worsefor the operation , as therei s much greater danger of peritonitis in such caseson account ofth e communication with the abdoIn inal cav ity be ing enclosed. I t i s important, therefore

,infiform ing a diagnosis, to be clearly satisfied

THE CANADA LANCET. 323

ara

and then to take care not to open the sac,

would render th e operat ion as dangerous ashern ia was congen ital .

As to the mode oftreating the_

cord . This

atter ofchoice many, no doubt, would pre

Ofseparation ofthe spermaticl igation , as being safer, and saycondary hemorrhage would have

case had i t been done. Still,me a good deal ofannoyance

,

consequence,

ie th e cord en masse. I t certainly

and I th ink quite as'

safe. I have

the operation , and have always

manner without any troubl e.

what i s the probabil ity Of a radind s imilar cases Is i t j ustifiable

these cases,may

the communicat ion with th e abdomishall part i cularly watch the case

,and

ingly, as I consider this a very im'

INTR A-UTER INE MEDICATIONJ. CATTERMOLE, M .D. , ENG . ,

LONDON, ONT.

R etrospect ofJuly, 1 8 73 , containsin s tructive paper by Dr. Loomber e th e Medical Society ofDublin :medication , which relates more

remedy,in the treatmen t ofseveral affection s com

mon to the interior ofthe womb, andfor h i s strongadvocacy ofth is invaluable aid in the face ofmuchvituperative and determined Opposit ion , h e is

enti tled to the thanks ofth e profess ion .

I t i s also due to Dr. Atth ill to s tate that be de

vised a very handy l ittl e speculum,by which , after

dilatation with tents,sufficien t cauteriz ation may

be eflected in many cases . How long diseases ofthe womb have been treated by strong caustics issomewhat uncertain

,but for the las t quarter ofa

century in America,th e British I slands

,and other

parts of Europe , i t i s wel l known that practitioners

have applied these remedies to the interior oftheuterus

,and usually by means ofa swab, or in a

d ilu ted form by inj ection . The latter method is

sometimes productive ofunpleasant symptoms ,whilst th e former

,if carefully done, i s general ly

safe , seldom followed by anything more than a l ittl e

un easin ess, not Often amounting to pain. I t must

be admitted , however, that by passing a swab

charged with its medicament quickly through th e

cervical canal much of th e remedy must be rubbed

offbefore reach ing the part intended for i ts reception . Many years ago, impressed with th e n eces

si ty ofmore complete appl ication Of the caust icmaterial, I utiliz ed open-ended catheters for th e

purpose, fi tted with st ile tte-swabs, formed by attach

ing to their ends l in t or cotton wool. Th is was

certa inly an improvemen t on the Old plan,but re

sulted in the destruction Of too many instruments .About four years ago, i t occurred to me that

tubes'

ofstrong glass might be advantageously,sub

st i tuted, as not being l ikely to be chemically acted

on by the material conveyed through them .

A clever chemis t in th is C i ty prepared three orfour of different cal ibre

,varying from two-eighths

tofive Or s ix-eighth s Ofan inch in diameter,an d

about n ine inches in l ength. Common catheter

stilettes , rigged up with cotton wool or l int, n icely

and securely attached to their ends,can be made

to act as piston-swabs. On the whole,I find these

tubes very far superior to any other contrivance

for the purpose . There poss ibly may be be tter,

if so , I am unacquainted with the fact. Glass

tubing is generally kept in great variety by drug

gists. By means ofheat i t may be readily con

verted into almost any shape and form desired.

Their end s should be rendered smooth,and each

tube may be gently ben t at about an inch and a

324 THE CANADA LANCET.

halffrom the end to facil i tate introduction , which ,afterdue dilatation wi th sponge or laminaria tents, canbe accompl ished easily and with the most perfect flask ofl iquor from h is pocket,safety

,by any one with a moderate amount ofproceeded to drink the contents .

manipulative tact ; and in cases where the os uteri his exit, and walked to the oppo

and cervical canal are patulous,one ofthe smaller street

,where he sat down

,and in

siz ed tubes can , without diffi culty, be passed with t ime was comatose. The druggist,out the previous use of tents, and thus the cavity

can be mopped ad libitum .For th e treatment ofsubacute and chronic endom etrit is, granul ar and congested conditions ofthemucous membrane ofthe womb

, u terine catarrh ,and carcinomatous growths above the inner 05

,

where topical treatment is demanded, these l ittle

i nstruments answer an excellen t purpose. In post

partum,and other forms ofu terine hemorrhage,

when solutions ofthe perchloride ofiron are hadrecourse to

,as the dernier ressort

,the ir s imultane

ous efflux will be rendered certain by using one Ofth e larger siz ed tubes. I need hardly state that feebly at 1

sol ids can be app l ied to the u terine cavity with and l ivid.

equal facil ity by the same means. were muchThese l ittl e Operations may be conveniently presenting

managed by placing the patien t in the usual sore throat

Obstetrical posit ion , on her left side a large vaginal audible art

speculum may then be passed wel l up to the signs of vomiting being l ikely to take place, I p rc

os tincae, and th e transit tube, previously warmed ceeded to reverse the syringe , as no stomach pum

and wel l Oiled , sl ipped through the cervical canal was at hand, so that I might be able to empty tb

in to the u terine cavity. In a few special cases the s tomach of its contents. However,i t would be

process may be more readily accomplished by no material benefi t,as the inj ury had al l been don

t ransfixing the anterior l ip with a fine tenaculum , long before I reached the patien t. He expireand

_

making sufficient traction to straigh ten the before I had the apparatus adj usted, having l ivec ervix ; sometimes instead ofan ordinary large, only forty-five minutes after drinking the acid.

plain speculum the duck-bill instrument ofSims R emarks — Had the druggist been at h is pos

may be more advantageously employed. or any equally qual ified person to attend to th

business,and administered a strong solution

saccharate of l ime, and an emetic at the same tim t

the chances Ofa favourable resul t would have beemuch better. But, instead ofthis being the C 3 5 4we find the druggist absent

,and a boy

,who kne

As we do not Often meet with cases ofpoisoning noth ing ofthe drug business,l eft in C harge.

'

N

from carbol ic acid , I beg leave to submit the fol solution ofsaccharate ofl ime was prepared,an

lowing. not procurable i n time to save the man’s l ife; A

Hugh Burns, a laborer, set. about 40 years, th ings considered, the druggist did well, I think, twhile under the influence ofintoxicating liquor

,inj ect the ol ive O il . The druggist

,moreover

,we

d rank from a tin cup, a solution ofcarbolic acid,reprehensible for leaving a strong solution 1

which was sitting on the stove in a drug store,carbolic acid exposed in so accessible a place. A

May 7 th, 1 87 8. The cup contained a strong solu regards the immediate cause ofdeath, I do n <

t ion ofacid, about 1% oz s., to water x ii, which had pretend to give a positive Opin ion.

been p laced there by the druggist for dis infecting Carbolic acid is well known to be a powerfi

POISONING FR OM CAR BOLIC ACID.

BY J. H . RYAN,M .D ., SUS S EX

, N.B.

’

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326 THE CANADA LANCET.

The censure of the medicalfaculty ofAnnArbor had not been indirect.” In the American

Medical Association charges had been preferred

against th e State Society because ofal lowing professors at Ann Arboi to represen t the Society, andat the late meeting ofthe State Society C harges

were preferred against the professors,thus making

the censure direct, though it seems to be the desire

to have the question , whether the profession will

sustain such mixed schools, settled by the Ameri

can Medical Association.

Very respectfully,

HENR Y B . BAKER .

Lansing, Mich.,June 3 , 1 8 78 .

fi shnet artistes.

TWO UNCOMMON FOR MS OF DISLOCATION.

Mr. A. W. Mayo R obson lately reported in theB r z

'

ti s lz Merlzcal y onrnal the following cases, onei s a dislocat ion of the jaw during an attack ofhysteria ; th e other is a dislocation ofthe sternalend ofthe clav icle upwards. The fi rs t is interestingon account ofi ts cause the second, on account ofi ts rarity.

I was called to see a woman , aged 30, said to bei n a fit. On arriving at the house, I found her inan hysterical attack

,and ascertained that she had

received news ofa severe family trouble a few hourspreviously. A curious symptom in th is case was

,

that she violently worked the jaw, and would persistin doing so despite being sharply spoken to andtreated freely with cold water. Whils t I wasobserving her

,the jaw sudd enly became fixed widely

open and d isplaced obl iquely towards the righ ts ide. She instantly began to scream violently, andapplied her hand to the inj ured part. I n eedscarcely say that the hysteria van ished, as if bymagic. I replaced the j aw i n the u sual manner

,

and appl ied a four-tailed bandage . After beingput to bed

,she had a return ofthe paroxysms, and

again worked the jaw but this time the bandageprevented displacement. The next day, beyond aconsiderable degree ofstiffness, noth ing,r abnormalwas found. I then ascertained that she had neverhad dislocation of the j aw

, on any previous occasion.

My reasons for recording the case is, that I findno men tion made ofany similar one either inHamilton on Fractures and Dislocat ions or inl mes

’s , Erichsen

’s,or Bryant’s works on surgery.

The history ofthe second is as follows. I wascal led on September e 7 th , 1 87 7 , to see a grammarschool boy aged 1 5 the messenger tel l ing me thathe had pu t h is shoulder out, hav ing fallen undef

was no dyspnoea , and an entire absence ofcrepitus.My diagnosis was dislocation ofthe sternal end ofthe clavicle upwards, -as the only acciden ts whichmight have simulated i t were separation oftheepiphysis and fracture the latter being negativedby the absence of crepitus

,and the former by thefact that ossification does not take place in the

epiphysis t i ll the eighteenth or twentieth year.R eduction was easily affected by drawing theshoulders backwards and raising the arm . I t ied ahandkerchief round each arm near the shoulder

,

and looped them together firmly behind placed apad in th e axil la pressed the elbow inwards bymeans ofa bandage round the chest, enclosing th earm -and supported the elbow and forearm in asl ing ; after which the symmetrical appearance ofthe chest returned. In the after-treatment

,there

was a great tendencyfor the sternal end of th eclavicle to sl ip upwards, as the boy, being unusual lyactive

,always contrived to romp abou t and loosen

the bandages as soon as h is attendant’s back wasturned . Although the appl iances were con tinuedfor three weeks

,and a figure-of-eight bandagefor a

fortnight longer,yet at the end ofthat time the

sternal end ofthe clavicle remained abou t half aninch above its usual level but the functions ofthel imb seemed to be in no way impaired. The onlycases I can find on record ofa similar nature arefour quoted by Malgaigne, two by Bryan t, one byDr. R ochester ofBuffalo, and one by Hamilton .

BONE FOR MATION -AFTER R ESECTIONOFTHE LOWER JAW .

The following is by B. von Langenbeck , in th etranslat ion ofthe “ German Society ofSurgery,”Sixth Congress.

GENTLEMEN I am perm itted to make th is bri efcommunication through the (as I may well say)exceedingly great attention which Prof. J . R .

Wood, of New York, has shown, in sending th ispreparation here from New York by his as sistant,Dr. Wiggin

,in order to allow it to be demonstra

THE CANADA LANCET.

t ed . Dr. Wiggin must return again to-morrow toNew York , and , al though our al lotted tim e is veryb rief, nevertheless I have deemed i t necessary topr esent this demonstration , because otherwise our

d istinguished American colleague would have sentu s th is really grand work in vain.

_ Prof. Wood , Surgeon to Bellevue Hospi tal, i nNew York , had the kindness to send me the photograph ofth is skul l las t fal l— a skul l ofwhich theentire under j aw has been extirpated on accountofphosphorus-necrosis

,and ofwhich the whole

l ower jaw,has

,in the course ofa brief time, formed

i tself anew ; and when , in my surgical lecture, Ihad showed and explained th is photograph

,1 d id

,not believe tno t a cor respondi ng p r eparation r eally.ex i stecl anyw/zere, he had the courtesy to send usth is skull with the newly-formed lower j aw. I wi llquite briefly presen t the h istory ofthe operation ,which is described in a short art icl e by Dr. Woodi n th e New York Journal ofMed icine for May

,

1 856 , as the R emoval ofthe entire Lower Jaw,for Necrosis caused by Phosphoric-Acid Gas.A gi rl— Cornel ia S .

— s ixteen years ofage,for

m erly always healthy,had worked in match-factor

i esfor two years and a hal f,one ofwhich was very

badly ventilated . She was occupied eight hours

327 t .

sl ightly. Some years later,Cornelia S . died of

abcess of the brain,and so Dr. Wood acquired the

possess ion ofth is skull,which stands before you,

and upon wh ich you observe the entire lower jaw,

with extremely complete form,only a very l i ttl e

smaller than the original must have been .

Formerly,cases ofphosphorus-necrosis came

into the C l inic here n ot infrequently, and scarcelya term passed in which some jaw-resect ions werenot performed . Thanks to the better ventilationin factorie s s ince 1 864, scarcely any cases havecome under observation

,and it appears that phos

phorus-necrosis will

,at no very distan t time b e

eliminated.

I have performed subperiosteal resection ofth eentire lower jaw six times— four t imes in conse

quence ofphosphorus-necrosis,and twice in con

sequence ofacute osteo-periost itis . In all thesecases re formation ofnew bones was observed, and ,indeed , as in the case Operated upon by Dr. Wood ,with most comple te restoration ofthe function .

When one extirpates the entire lower jaw fromunder the periosteum at one sitting, th e chin mustinvariably recede . The room for the formation ofthe new lower jaw is restricted by muscles, namely,by th e genio-gloss i the contou r ofthe new lower

d aily in packing matches,but enjoyed the bes t of jaw developes imperfectly, and the chin-portion Of

health until May, 1 55 . At that t ime there tookplace, along wi th toothache , a swelling of the lower

j aw, with suppuration . The patient,however

,con

t i nned her work up to December,1 855 .

Upon her reception in to Bellevue Hospital ,t otal necrosis ofth e righ t

,and part ial ofthe left,

lower jaw existed , with profuse suppurat ion . Thepus poured for the greater part into the cavity oft he mouth , and outward through a fistulous openingi n the lower border ofthe mandibula. Notwi ths tanding th is

,her general h eal th had remained

good , and her appetite good,only chewing was

v ery much impeded.

On th e 1 9th ofJanuary, 1 856, Dr. Wood made.a resection ofa part ofthe right lower half ofth ej aw , with most careful saving ofthe periosteum

,

and wi th preservation of the C h in-port ion oftheflower j aw. Heal ing resulted without interruption ,b u t i t s oon became eviden t that the entire remaini ng under jaw was diseased also , and this had l ikew ise to be removed on the 1 6 th ofFebruary

,28

d ays after the fi rs t operation . Except ing the re

t raction ofth e tongue ensuing upon the removal oft he jaw

,and the choking symptoms induced there

b y, th e good effect ofth e operation and the heali ng ofthe wound remained uninterrupted, and inMarch , 1 856, the patient was able to be discharged,"

r ecovered .

The reformation ofth e bone was complete, andthe function ofth e new lower jaw left nothingfurther to be desired. In the photograph taken atth is time

, you observe the admirable contour ofthelower jaw,

ofwhi ch the chin-portion only recedes

it,

retreats more or l ess perceptibly. In order toobviate th is evil

,I have

,l ike Dr. Wood, made the

operat ion at t wo cz’zfi’ér en t times , and at firs t cu t out

from the periosteum the smal ler portion ofthemandibula— which was

,however, most d iseased

leaving the ch in and larger portion alone, and then ,after four or s ix weeks, resected the remainder.But even then

,as th is photograph and the descr ip

t ion given by Dr. Wood ind icate , th e lower j aw i salways smaller, and the normal prominence ofth echin is lacking.

This evil is almost completely avoided, i f, asBillroth has recommended, one leave behind inposition

,osteophytes from the necrosed bone, i n

immediate contact with the periosteum . Thisphotograph shows you such a case. I Cut out firstthe smaller part ofthe necrosed jaw-bone, and,after new bone could be dis tinctly fel t— six weekslater— I cu t out the greater part, with the C h inportion. The resected jaw here shows you thatosteophytes were left almost completely around .

The photograph,which is taken hal f in profile

(August Matthe’s ; ) shows y ou tha t the contour of

the lower jaw is very comple te, and that the ch instands out i n the normal manner.

The skull sent to u s by Dr. Wood settl es at oncethe question ofthe durabil ity ofthe newly-formedbone . I t has

,indeed , been repeatedly maintained,

that the newly-formed bone , after subperiosteal resection

,cannot be ofa durable kind , bu t that i t

subsequently must be reabsorbed. At al l events ,th is may happen

,and I have mysel f seen it in th e

case of a woman suffering from phosphorus-necro'

328 THE CANADA LANCE’

I'

.

sis ofthe lower jaw,much reduced by long suppu diarrhoea. She had taken opium freely by the

ration,whose lower jaw

, n ewly formed after resec mouth and also hypodermi cal ly but n otwi thstandt ion

,was

,after a twelvemonth

,almost entirely ing, the d isease had rapidly increased in severity.

reabsorbed. Such an absorption ofbone is, how We were both ofOpin ion that,unless a favourable

ever,a rare occurrence in my observation

,and I

can testify to the unchanged pers istence after yearsofthe new bone-formation , after subperiosteal ext irpation ,

as well in the lower jaw as in long bonestibia

,rad ius

,05 metacarpi poll icis.

Dr. Wood’s patient d ied some years after theoperation

,and yet you see the new lower jaw pre

served in all its parts, al though a trifle smaller thanwas the original j aw.

—1V. Y.fli ed . y our .

ON PUER PER AL FEVER , BY G . W . WOOD ,

M .D , FAR IBAULT,MINN .F

_

or upwards oftwo years I have u sed themedicine

,or combination

'

ofmedic inal plants,i h

troduced to the notice ofthe profession by Dr.Kerr of Galt

,Canada

,in th is Jou rnal , 1 865 , 1 86 7 ,

and 1 8 70 and afterwards by h imself and others innumerous papers in th e C anada Lancet, 1 8 73 ,1 8 74, 1 87 5 , and Adhering to the principlelaid down by Dr. Kerr, that the med icine has acurative power over tenderness or ulceration ofthemucous membrane, I have employed it in dysentery,d iarrhoea, scarlatina, and measles. My experiencehas been ch iefly in dysentery ; from this diseaseevery patient has recovered and in many a severeillness i t has helped me to save life

,so that I have

great cause to be satisfied. More recently,in con

sequence ofa requestfrom Dr. Kerr,who called

my attention to a case in the C anada Lancet, byDr. McDonald , W ingham ,

Ontario,I have given

i t in well-marked puerperal fever with the mostgratifying results.CAS E I.

-Mrs . A., aged 28

,mother ofseveral

C h ildren , delivered, after an easy and quick labour,by my partner, Dr. R ose, on the n ight ofth e 26th

ofMay 1 8 7 6.For several months previously sh ehad been threatened with miscarriage. Dr. R .

l eft her comfortable at 2 a m ,but

, on call ing duringthe day, found rigors frequent

,small pulse

,

tympanit is, and all the symptoms ofa severe attackofpuerperal fever.I visi ted her in consultation near midnight ofthe

28th. She was ly ing on her back,knees drawn up

,

abdomen very tympani tic,and exquisitely painful

to the touch sl ight del irium,peculiar anxious ex

press ion ofth e C ountenance pulse small,thready

,

and very rap id ; Sk in hot and dry urine s canty andhigh coloured loch ia had not en tirely stopped no

I The componen ts are dulcamara, stramon ium , s iuml ineare , cicu ta maculata, con io-solinum C anaden se, and

e i ther d igi tal is o r squ i l ls theformer being styled the Digitalis ,the latter the S qu i ll C omb ination . Experien ce hav ing shown

that these are not su ited to some exceptional cases , Dr. Kerrhas in troduced a third comb ination ( C anada Lan cet, July

s tyled the S trychn ine.

change occurred very soon , the patient had not long'

to l ive. We resolved to give six and a half grainsofthe d igital is combinat ion

,withou t opium

,every

four hours, with an occas ional hypodermic injectionofmorphia as the case might require. In twelvehours the symptoms were considerably improved

,

recovery dating from the first dose; indeed , thebenefi t resulting from each , could be plainly seen .

The recovery was so rapid that by the 3 r st of Mayshe was entirely out ofdanger

,and on th e sth of

June we ceased to attend . After the digital is combination was commenced

,only two hypodermic in

jections were given .

CAS E I I — Mrs J. , del ive red in the country ofher first ch i ld on August sth . On the 1 2 th wasdoing well , and moved into th is c ity, a distance oftwenty-three miles. O n the

“

1 4th was seiz ed witha severe chill , great pain , tympan itis, &C . Dr. R .

was sent for, who gave opium and quinine veryfreely, but she continued to get worse. I was

called at 4 a m , August i 7 th , and found al l thesymptoms ofa severe attack ofpuerperal fever.She had intense pain in the abdomen ; tympanitis .was not so excess ive as in last case , but she hadprofuse diarrhoea unchecked by the doses ofopiumand quin ine. We gave her six and a hal f grains ofthe digital is combination without opium every four'hours. In twelve hours

,pain had nearly ceased

,

and in twelve more,diarrhoea having terminated

,

she was out of danger. By the z r st She was greatlybetter. The recovery was so rapid that seven visitscompri sed my attendance. From the hour I firstsaw her, no opium was given , but the digital is combination was continued for some time in the samedoses as at firs t.

CAS E I II .— Mrs R . , aged 30 , had early II)pregnancy such severe and persistent vomit ing thati t induced uterine contractions and a tendency to

m iscarriage, with occas ional flood ings , wh ich oc

curred throughout her entire pregnancy. She wasso reduced in strength as to be obl iged to keep herbed more than three-fourths of the t ime. Theseunpleasant symptoms were only controlled by morph ia given hypodermically. She was del ivered at

6 a m,on sth December, after an extremely severe

labour lasting twelve hours during six of these,

she was under chloroform . The child (her first) ,which weighed nine and a half pounds

,had a large

and unusually firmly-un i ted head. Th irty-six hoursafter del ivery a very severe chi ll ushered in puer:peral fever. She had intense pain

,increased by

the sl ightest pressure,tympanitis

,bad facial expres

sion , cold sweats, sligh t de l irium ,and all the

symptoms men tioned in Case I.,d iarrhoea being

l ikewise absen t. We d ecided to give six and a halfgrains of the digital is C omb ination without Opium

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THE CANADA LANCET.

that the secretion of the intestinal canal contains1 . A ferment capable ofd issolving certain oftheproteids as boiled fibrin . 2. One which possesses

i n a singularly high degree the power ofconvertingcane and m ilk sugar i nto grape sugar. ClaudeBernard has lately reinvestigated th is fermen t andfinds that it can be d issolved and precip i tated bythe reagents wh ich dissolve and prec i pitate theother unorganiz ed ferments ofthe body. To it hegives the name ofznz'cr tzneferment.— D etract

CHLOR ATE OF POTASH IN CATAR R H OFTHE BLADDER .

Prof. G. Edlefsen , ofKiel , publ ishes in theDentsclz. Arc/zi t} .Klin . M ed . xix. ,

an essayon the treatment ofcatarrh of the bladder bychlorate of potash . The view lately advanced thatthe best method oftreating cystitis, even acutecases ofi t, consists in the introduction in to thebladder

,through the urethra, ofwater or medicated

fluids,i s not in accordance with h is observation

,

The remedy he recommends is chlorate of potash .

wh ich n ever damages the stomach or any otherorgan

,and subst itutes turpentin e perfectly in cases

where turpentine cannot be given .

That the chloric acid salts,when administered

internally,pass into the urine

,was demonstrated in

1 856 by Lambert . The value ofth e chlorate ofpotash in affection s ofth e m outh and pharynxleads the author to their administrat ion in affectionsOf the bladd er, the epithel ium being in both casesal ike of the pavement variety. The action ofthisremedy seems confined to this variety, as it has noeffect upon the trachea or bronchial tubes . I tsaction is not to be explained by simp l e contractionof the muscular coat ofth e vessels

,as i t not only

reduces the hyperaemia and catarrh,but also closes

ulcers over quickly as if i t exercised a specifi caction in the reproduction ofepith el ium . Theauthor’s resu l ts were extraordinary

,stil l there are

cases in which he failed with i t,and was compelled

to resort to turpentine and copaiba . He orders foradults u sually : Potass. , chlorat . aqua dist.

,

3O O°

O,ofwh ich a tablespoonful every two or th ree

hours . He lays s tress upon the prescription because i t is n ecessary to bring the patient under th ein fluence ofth e remedy quickly. Should the tasteofth e drug after long admin istrat ion become insipid or sickening, i t may be corrected by usingcherry laurel as a vehicl e ( 1 0 O— 3O O O ) any syrupshould be avoided . The pus begins to disappearfrom the urine after its use very qu ickly— an im

portant d iflerence from the action ofsalicyl ic acid— and the subj ective d istress i s lessened or d isappears even before the pus has ent irely vanished .

T/zc D octor .

FATAL HEMOR R HAGIC SMALL-FOX.

BY L. D. BULKLEY, A.M .

,M.D . ,

NEW YORK.Two years ago . I reported a case ofunrecog

n iz ed ,fatal hemorrhagic small-pox in the mother,and fatal small-pox in the n ew-born child, andwith in a year later I was called in consul tation byanother physician to see a similar case, which hadbeen previously seen by one physician OfNewYork Ofsome eminence without recogniz ing i tsnature . This case was also followed by a case ofordinary small-pox in the person ofthe husband ,who recovered. From these cases having passedunrecogniz ed by several physicians, I deem thatthe existence ofthi s rather rare form Ofthe d iseasei s not a wel l-es tabl ished fact in the minds ofallpractitioners

,and therefore think the subj ect worth

presenting again by means ofthis second fatalcase. Th is appears to be the more necessary because there i s no good descript ion ofth ese 1 ecul iar features in the text-books on general medicineor dermatology.

Mrs . E.,aged 39 , a good-siz ed and previously

healthy lady,five days pre vious to my seeing her,

was seiz ed with a ch il l,which was not very severe ,

followed by nausea and vomiting, with some fever.Two days after the chil l sh e began to get flushedin the face, th e flushes being of a purplish and

rather l ivid hue,and on the third day some ecchy

motie spots appeared on the neck and chestDuring th is period there was some pain in the back ,but this was not severe

,and th e nausea and vomi t

ing had yielded soon to bismuth . During thesefi rst few days there was no sign ofa papular crupt ion

,nor at any t ime was there an amount of any

lesion which would be considered as distinct ive OFsmal l-pox. Hemorrhages began from the mouthOn the th ird day

,and soon extended to other loca

li ties, pers isting unti l death .

When I saw her, April 24, 1 8 7 7 , the face presented an evenly d is tributed , purplish , l ivid hue,withfew i f any blotches, but scat tered over thepurple surface

,a few minute papules could be dis

covered on close examination. The neck an d

chest were covered w ith a thickly set eruption ofpetechiae

,confluent in some places ; on the abdo

men,where a mustard-plaster had previously been.

placed,there was an evenly formed ecchymoti c

surface ; the back was pretty well covered withpetechiae. On the th ighs the hemorrhagic spots:were separate and distinct

,of an irregularly round

ish shape ; they were more th ickly set upon thebuttocks . The legs were more sparsely sprinkledwi th them

,they reach ing even on to the toes. The

arms were affected in l ike manner, the erupt ion ofhemorrhagic maculae ofvarious siz es and shapesextend ing on to the hands, and even to the fingers,mainly on their backs.On many ofthe petechiae very close inspection

THE C ANADA L ANCET. 331

with a . pocket lens ofmoderate power, showedal though but a compar t tively

smal l number ofth e hemorrhagic spots exhibitedthem . On th e roof ofthe mouth there wereseveralfairly developed pustules with rupturedsummits .The ey es were intensely ecchymotic, th e tissues

of th e righ t eye were raised up i n a circular ringaround .the i ris, which appeared as a great d epression in the centre ; th e l eft eye was l ess affectedthan the righ t, bu t '

was th e seat Of considerabl eblood y effusion .

The mouth and nose were pouring forth blood,blood was passed by the bowels

,there being al so

considerable pain through the abdomen,and th e

urine was seen to be loaded with blood in streaksand clots .The pulse was 1 20, full and th robbing, tempera

tu re, tongue d ry and parched ; th e bowel shad been previously moved by ten grains ofbluemass, and she was having loose, bloody stools .She was conscious

,answering questions cl early

,

and ass is ted somewhat in the examination , wh ichwas very brief, but she complained much ofgreatgeneral d istress. She was bled to abou t twentyounces, the blood flowing with some d ifli culty andbeing ofa very dark color. Twenty-five minimsoffluid extract ofergot were inj ected hypoderm ically into the arm, and th is was directed to be re

peated every two or th ree hours. Brandy was tobe administered tolerably freely

,and to be given

by hypodermic inj ection if vomited .

The patien t expressed herself as experiencingth e very greatest rel ie f from the bleeding ; thepulse became more natural

,and she sl ept. I

have not received from th e attending physician thepromised d etail s ofth e case after I left her

,and

only learned that sh e sank and died within twelvehours after my visi t. The family were ordered tobe vaccinated at once, bu t the husband took th edisease, as before stated, and was severely affectedI bel ieve all the others escaped .

The interesting points attached to the case arethe pecul iar variety of th e disease, th e small-poxpoison manifesting i tsel f almost entirely in th eform ofth e hemorrhages

,and th e consequent d if

ficulty Of the diagnosis the almost surely fatalnature ofth is variety ofvariola ; and the necessi tyofa correct diagnosis for th e sake ofthose aroundthe patien t.

In regard to th e diagnosis,I need only say that

the entire group ofsymptoms as detailed in th iscase can be presented with no other d isease purpura hemorrhagica wh ich i t most resembles

,would

not have the initial ch il l,nor the fever and throb

bing pulse of1 20, nor the papules on some ecchymoses and the vesicles or pust ules on the others .Black measles , or black scarle t fever, the hemorrhagie varieties ofthese diseases would al so nevergive th e pustular element

,moreover would not be

NEW YOR K ACADEMY OF MEDICINE.

FALLOPIAN PREGNANC Y.

so rapid in progress or so violent in character : andwould possess other features charactertistic of each ,as the catarrhal symptoms of measles and thethroat diseaseofscarlatina .

As to th e treatment,l i ttle if anything has ever

availed the cases are almost surely fatal, and thatgen erally with in from three to fi ve days. I t wasmy pa inful duty to tel l the husband that h is wifecould hardly, by any poss ibil ity, l ive. The treatmen t followed was such as I should be incl ined toagain advise

,except that i t should be resorted to

much earl ier in the d isease . The bleeding wasindicated

,inasmuch as the throbbing pulse was

already seeking rel ief by hemorrhages from th emouth , nose, kidneys, and bowels, and by thusOpen ing a vein an impression was made on th ecirculation , and the patien t was certainly verymuch rel ieved . I should hope most from thehypodermic injection of ergot

,which was immed i

ately given ; bu t the disease had progressed too

far, and i t was possibly not absorbed. I n anearl ier case I should expect someth ingfrom i t.TO O much care can hardly be exercised in recogn iz ing cases ofthis terrible form ofsmal l-pox , as,if undetected , they may give ri se to very seriousconsequences

,as in this and the other instance

which I have previously reported — Medical R e

Dr. Laurence Johnson reported (New YorkAca

demy ofM edicine) a case ofFallopian pregnancyoccurring in a woman set. 29 years, married , andth e mother Oftwo ch ildren aged respectively fou rand a half and two and a half years. She had always been heal thy. Her las t menstruation commenced 011 the n th of February

,1 87 8, and con

tinned the usual length oft ime— three or fou rdays . There was no evidence ofpregnancy exceptthe non-appearance ofthe menses on March 1 1 th .

O u March 23rd , at about noon , she suddenly beganto suffer from pain referable to the pelvic region

,

became faint, and was put to bed . Small quant it ies of brandy were given at intervals

,and sh e par

tially regained her strength , but in the even ingthere was a return ofth e faintness. She vomitedonce or twice, and had an evacuation from thebowel s. The doctor saw her for the firs t t ime soonafter the attack offain ting in the evening ;foundher very pale, with a feeble pulse, 1 40 , but therewas no discharge ofblood from the vagina.March 24th

— Patien t appeared somewhatbrighter ; pulse somewhat stronger, bu t rapid .

Urination without pain abdomen somewhat tym

pan itic tenderness al l around the u terus,but espe

cially upon the right side. Pain was not a promi

332 THE CANADA LANCET.

nent symptom at any time during the entire h istory Dr. Post referred to a case reported to the IaOfth e case, although at no t ime was she markedly tem ational Medical Congress by Dr. ofunder the influence ofnarcotics.(March 25 th.

— Patient sank rapidly, and was th

though t to be dying. She rall ied , however, sothat on March 26th she was comparatively brigh t.On the nigh t ofth e 26th she sank and d ied,fourdays from her first attack offaintness.Autopsy

,twenty-four hours after death — Pelvic

cavity fi l led with blood. R uptured cyst in therigh t Fallopian tube

,close to the uterus, and pro

bably not larger than a hickory nut. R igh t ovarycontained a recent corpus luteum . Uterine decid ua very apparent. Little or no evidence ofperitonitis.Dr. Johnson raised the following importan t

question Would not an operation ,w i tic ti zc view

ifsecur ing blood-vessel's , Izawe beenfeas ible and j ustifi able immediately after t/ze occur rence oftbc fi rstlzenzo; rnage on tfze 23 rd ofMarc/z 2

METHOD OFTREATMENT ,SUGGESTED BY DR . EMMET.Dr. T. Addis Emmet, in the l ight of a case re

ported by Dr. McBurn ey, and which was seen inconsultation by Dr. Thomas and himself

,bel ieved

i t to be a feasible operation , as soon as th e Fallopian pregnancy was recogniz ed, to firs t dilate theu terus

,then dilate th e tube, and in that manner

r emove the foetus. Dilatat ion ofth e uterus tookplace when only a moderate quan tity of fluid wasenclosed in its cavity

,and at th e same time

the fluid backed into th e Fallop ian,tubes.

He,therefore, was perfectly satisfied that with

proper instruments , the uterus could be safelyd ilated, and also the Fallopian tube, and, as thecyst was usually near the body ofthe u terus

,its

contents could readily escape into the cavity Ofthe uterus when such dilatation was effected . Dr.Emmet then exhibited an India rubber cot

,such

as he had been in the habit of using during thelast ten years for the purpose of dilating theuterus. The dilator was manufactured by ShepardDudley

,and cons isted ofan India rubber cot

containing a tube into which a sound could be introduced , so that i t could be carried to the fundusofthe u terus an additional fixture perm i tted theattachment ofa Davidson syringe

,by means of

which the cot could be distended to any degreerequired. When the uterus had been d i lated

,a

curved sound could be used,and the ' cot intro

duced into the Fallopian tube,and -the dilatation

p roduced as in the former instance.

FEAS I B IL ITY OFA SURGICAL OPERATION.

Dr. Emmet was Of the opinion that as soon asrupture Of the cyst occurred i t was a proper operation to immed iately open the abdomen ands ecure the bleeding vessel s ; for in comparisonwith such operations as ovariotomy

,Opening the

abdomen for that purpose was a simple affair.

Georgia,in which laparotomy was performed for

at purpose,and with good results.

Dr. Sel l approved ofthe Operation — Medical

A NEW FUNCTION OF THE LIVER .

Prof. Schiff and Dr. Lauterbach bring to generalknowledge

,a new function ofthe l iver, and the 283

experiments which are made the basis ofthe work,

were carried ou t by the latter in the laboratory ofth e former

,under his direction . I t 15 known that

ligation ofthe portal vein in an an imal , produces acond ition s imilar to that caused by morphinesensitiveness to touch , diminished sense ofpain ,retarded pulse , pressure ofblood in the arterialsystem

,first increased, then diminished

,slow

stertorous respiration , and the animal dies withou tconvuls ions. Dogs hold out about fou r hours

,

cats and puppies succumb sooner. A new hypothesis i s presented in the work before use

,i n ex

planation ofthis phenomenon . Many animalsproduce in their organ ism a powerful poison

,under

normal conditions,which 13 eliminated by special

glands,in others, as in dogs and eats

,a poison i s

formed under pathological conditions,such as

hydrophobia. I t 18 poss ible that a poison is formedi n th e organ i sm ofall animals , and that they wouldsometimes perish by self i nfectlon if they were notprovided with an organ in which this poison isdestroyed. The organ to which th is function belongs is the l iver, and the symptoms which resul tfrom ligation Of the portal vein have their origin ina collection ofthe toxic products in the blood.

Thirty-four frogs were inj ected with the blood of adog which died after l igature all Of them presentedsymptoms similar to those of the dog

,and died

after three hours. In order to prove whether thel iver

,which destroys the toxic principle in th e

organism , exercises the same influence on otherpoisons

,Lauterbach made the following experi

ments h e ascertained the dose ofnicotin whichwas suffi cien t to kill a large dog if inj ected into the‘general circulation the same dose injected intothe smal l intestines and mesenteric veins of otherdogs produced only feeble symptoms ofpoison

,

which quickly disappeared ; a double dose is notsuffi cien t to kil l a dog when the poison passesthrough th e l iver before i t goes into the generalcirculation an inj ection

,five times dilu ted

,killed

a dog whose portal vein was tied. A further seriesofexperiments showed that the direct contact ofthe l iver-sub stance with the n icotin

, Was sufli cien t

to deprive the latter ofi ts po isonous qualities . I fthe l iver of a puppy is injected with t o cc. ofwaterand a tripl e dose ofn icotin , and the fluid obtainedis inj ected in to the subcutaneous cellular tissue of

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THE CANADA LANCET.

migration ofleucocytes in man , showing that cl in ical 1 colonial offspring, who del igh t to flou t their grandObservations and pathology confirm in th is respectexperimental physiology. I t has been known forsome years that

,when a fine-coloured powder l ike

carmine is inj ected into the vascular system Of ananimal

,the white corpuscles seiz e on the small

granules,envelope them

,and carry them through

the vessels. They can readily be followed throughthe circulation

,and i t i s easy to show their passage

through the walls Of the vessels, and their extravasat ion into the cellular t issue. In malarial fever andthe resulting melanaemia, pigmented deposits arefound in d ifleren t tissues, particularly in those mostin contact with the blood , such as the vascularwalls . These deposits are derived fi rs t ofal l fromthe red blood corpuscles

,which are destroyed in

the spleen . The white corpuscl es take up th edebris ofth e red on es, and form with this the pigm en ted masses found in the walls ofthe vesselsand different tissues. This migration is very active.In countries where malaria is common the yel lowishearthy tint which is due to general pigmentation ofthe t issues

,and consecu ti ve to a migration ofthe

white globules fi lled with pigment, sometimes appear after only two or three attacks offever. —I de

BR ITISH DEGR EES AND COLONIALPR ETENSIONS.

Just now,when we are very properly arranging

to give privileges ofpract ice in Great Britain tocolonial graduates , may be the proper time to securethe l ike privilegesfor our own graduates

,who in

some colonies sufferfrom the appl ication ofa strictlyprotectionist system by ind igenous examin ingboards . The C anada Lancet points outI f, however, we ask for our graduates the

privileges enj oyed in England by home-graduates,

we must at least be prepared to concede someth ingin return . I t seems that there i s amongst ourOntario Medical Council a feel ing ofj ealousy thatmakes them resent a man ’s going over to GreatBritain and obtain ing h is qual ifications there ratherthan here. I t i s looked on as a sligh t to the College,and as an attempt to set i t at defiance, and ispunished by a refusal to register h is British qual ifications without further examination here, on theostensible ground that these qualifications are conferred by irresponsible close corporations

,instead

of, as here , by a body chosen by the profession andresponsible to i t for the proper performance ofi tsduties.”The assumption of superiority which covers the

special pretension ofthe Ontario Medical Councilis not a littl e amusing ; nor is i t altogether uninstructive to note how the exaggerated talk which iss ometimes heard anent “ i rresponsible closecorporat1ons i s -taken _ azc grand .rérz

'

enx by our

mother with her supposed shortcomings, on however slender evidence . The fact i s, that there isno such th ing in the three kingdoms as an irresponsibl e close corporation of medicine, sofar aswe are aware ; no one which is not responsible toits own Fellows , to the General Medical Council ,and to Government. But

,i n any case, the joke of

a Canadian board turning up its nose at Englishdiplomas, and refusing to admi t them to regi stration

,i s too funny to be seriou s, and too nearly

serious to be treated as al together humorous . Weare surprised that th is “want ofreciprocity ” wasnot m entioned lately at the Medical Council, whenthe subj ect Of colon ial degrees was being discussed.

— B r i tirnMed . y oarnal .

DIR EC TQMETHOD OF AR TIFIC AL R E

SPIR ATIONFOR THE TR EATMENT OFAPN( EA FR OM DR OWNING

,ANE STHE

TICS,STILL-BIR TH

,ETC .

BY BEN] . HOWARD, A.M .,M .D ., ENG.

R ULE I.-For Ej ection and D rainage offl u ids ,(am,from tire S tonzacli and Lungs .

Pos i tion and action of0perator .—Place the left

hand wel l spread upon base ofthorax to left ofspine, the right hand upon the spine a l ittle belowthe left, and over lower part ofstomach . Throwupon them with a for ward motion al l th e weigh tand force the age and sex ofpatient will j ust ify,ending th is pressure oftwo or three seconds with asharp push

,which helps to j erk you back to the

uprigh t posit ion . R epeat this two or three times,according to period ofsubmersion and other ind ications .

R ULE II.— To perform Ar tificial R esp i ration .

P os i tion ofPatien t. —Face upwards ; the hardrol l ofcloth ing beneath thorax

,with shoulders

slightly decl ining over i t. Head and neck bentback to the utmost. Hands on top ofhead.

(One twist Of handkerchief around the crossedwrists wil l keep them there .) R ip or strip clothingfrom waist and neck.

P os i tion of0perator .— Kneel astride patient’s

h ips ; place your hands u p on h is ches t, so thatthe ball ofeach thumb and little finger rests uponthe inner margin Of the free border Of the costalcartilages, th e tip ofeach thumb near or upon thexiphoid cartilage, the fingers fi tting in to the corresponding intercostal spaces. Fix your elbowsfirmly, making them one with your sides and hips ;thenAction of01>erator .

—Pressing upwards and inwards towards the diaphragm ,

use your knees as apivot, and throw your weight slowly forward two o r

THE CANADA

three seconds un til your face almost touches thatofth e patien t

,ending w i th a sharp push wh ich

helps to j erk you back to your erect kneeling posit ion. R est three seconds then repeat this bel lows~blowing movement as before, continuing i t at therate ofseven to ten times a minute ; taking theu tmost care , on th e occurrence ofa natural gasp

,

gently to aid and deepen i t into a longer breath,

unti l respiration becomes natural. When practi cable, have the tongue held firmly out ofon e cornerof the mouth with thumb and finger armed withdry cotton-rag.

APPL ICATION OFTHE D IREC T METHOD TO C AS ESOFSTILL-B IRTH .

The ch ild l ies along the left hand of the Operator, the ball ofwhose thumb takes the place ofthehard rol l ofclothing. Over this the shoulders decl ine, the head falling back with arms, if conven ien t, on either s ide Of the face . The buttocksand thighs are supported by the Operator’s fingers.Thus , th e operator has the prominen t l ittl e thoraxcompletely with in th e grasp ofh is right hand, withfirm counter-pressure beh ind

,enabl ing h im to

apply, locate, distribute, d irect, and alternate h ispressure as he pleases.C ase w/zic/zfi r st suggested t/zis application oftri c

D i r ect M et/rod , ot/zer met/zods being , under the ci r

cumstances, i napp licable.— I was called to apply theforceps in a primiparous labour

,which had already

las ted n early three days . I t was a seven months’

ch i ld, and , as I had apprehended , i t presentedwhen del ivered no present sign whatever ofl ife,and from its colour no future prospect ofi t. Coldair, spanking, hot and cold water, &C .,

naturallyproved useless . Division ofthe cord

,I was sure

,

would be final to any l ingering possibil ity Ofhope.Tethered between th e th ighs ofthe mother

,the

method s ofMarshal l Hal l and ofSilvester wereal ike impracti cable. Holding the ch ild in my lefthand , I proceeded , however, with th e D irectMethod , as described above, stopping now andthen , and making, quite unaided, mouth-to-mouthin sufllation . In about twenty m inutes the ch ildcommenced to breathe

,and she is n ow one .ofthe

most v igorou s girls I know. During the entireprocedure, with the exception Of th e head andshoulders, there was no exposure either ofthemother or child.

THE ORIGIN OFTH IS METHOD .

Notwithstanding more or less ofth e experiencesj us t narrated, in my lectures in the Univers ity ofNew York, as al so at the Long Island CollegeHospi tal , I allowed myself to teach only theauthoriz ed methods ofMarshal l Hal l and ofS ilvester. An event, however, occurred which nuexpectedly compelled me to ‘ consider the entirequest ion from a new standpoint. From a report Ihad prepared , i t appeared that, of the ( I th ink) 244

335

deaths from drowning during the previous yearwith in the metropol i tan dis tric t ofNew York , notone appeared to have been reached by a med icalman in timefor an attempt at resusci tat ion .

Under the auspices ofth e New York Board OfHeal th

,I endeavoured to solve the problem

whether i t was not possible for the harbour pol ice,who more generally rescue these unfortunates, tobe made competent also to do someth ing for the irresuscitation . Ordered to headquarters in squadsfor th e purpose

,I tookfor my guide the publ ished

Instructions Of the R oyal Humane Society and ofthe National Lifeboat Institu tion ofEngland, andendeavoured to teach them to these men accordingly. T0 make these methods understood I certain ly tried most earnestly and fai thfully, but ascertainly did I most signally fail . These men hadbut l ittl e notion Of gravi tat ion , less ofrespiratorymuscles

,and the relation between the motions

taugh t them in either ofthese methods and themotions they could see in simple natural breath ingthey somehow always failed to comprehend . Theylearned

,therefore

,accurately, l i ttl e or noth ing of

ei ther method,and in the excite ment ofa subse

quent emergency their notions and motions weremore confused than ever. My only incl inationwas to abandon the whole matter. The responsibi lity, however, was a serious one, and I accord‘

ingly undertook to see how far the methods inquestion could be s tripped of superfluous motions;how the essen t ialfeature Of al ternate thoracic compression and expansion , common to both and allmethods

,could be presented in the nakedest

s implest form . The resul t was that , instead ofthrowing the men a nut to break their teeth upon ,I was afterwards able to give them simply thekernel ; th is kernel was the Direct Method . T hisname I gave i t at once, because, in contrad istinc

t ion to the indirect ways ofthe other methods , bythese rules the two or three th ings to be d one aresimply done— done as they would be in any othermatter ofdaily l ife . The tongue i s to be brough tforward i t is pulled forward . The chest i s to bepressed

,— i t i s pressed — and that without waste of

time,strength

,or motion . The resul t of the

change was to al l concerned very gratifying. Thefi rst day I 1 entured to teach the Direct Method ,R ule I. ,

was made to explain i tsel f in a way I d idnot intend

,th e volunteer subj ec t having but j ust

had h is dinner.I n explain ing R ule I I . , having put a com r ade

patient in position,with black ink I described by

continuous outl ine the l ips,trachea

,apex and

conical contour of the bony walls ofthe airand with red ink marked th e l ine ofthe diaphragmat i ts base. Besides th is a mateur patien t I placed

,

an Old-fash ioned pair of kitchen bellows keptwidely open by a spiral spri ng at i ts base. I needhardly say the noz z le, windpipe, hard conical s ides ,pl iant leather base, presented sufli cient s imilarity,

THE C ANADA LANC ET.

to the ink outl ines I had'

made on the patien t tobe quite amusing. But in illustrating simul taneouslythe action Ofth e operator

,both upon the one and

upon the other,side by side, the manifest com

pre ssion , rebound , and audible gasp , presented ananalogy so complete

,all I had to say about the

steady increase Of pressure ending with a shortpush

,about the rhythm , the persis tence, the gentle

n ess to be employed, as in reviving a dying ember,was entirely anticipated

,and each man I found on

the fi rst lesson to be as competen t as h e was impatient to “ blow the belluss,

” as he called it, ofhis comrade. The lectures were henceforth anticipated by the men as much as for the entertainmen tas for the instruction . I t so happened th e nextmorning one ofthis first squad fi shed out an un

fortunate man who had sought rel ief by drowningnear Catherine Ferry ; and though for twentyminutes after rescu e he gave no S ign ofl i fe, thispoliceman succeeded in establish ing respiration

,

and within two hours the man was able to returnto his lodgings — Tbe Lancet.

ELECTR OLYSIS OF SCR OFULOUS LYMPHATIC GLANDS .

Mr. Golding Bird has contribu ted a paper on

th e treatment of scrofulous lymphatic glands , bythe electrolytic caustic. He referred to the growingdisuse ofcaustic. He divided cases of scrofulou sglands into three classes 1 . The glands free,though enlarged . 2 . The glands matted together,or to the skin , or presenting hardened nodules , or

encapsuled ( lymphoma) . 3 . The condition ofactive inflammation . The first-class was met bygeneral treatment. In the second i t was better touse the knife . In the third the best operation wasby caustic ; and the least painful ofany mode Ofapplying i t, was the one now described. A smallarrow Ofshee t z inc, on e inch and a half long byhalf an inch wide

,sharp at one end , had a copper

wire ten inches long attached to the other. Theother end ofth e wire was soldered to a plate Ofthin sheet silver or copper, three or four inchessquare : The latter was firmly strapped upon apiece ofl int, wet with salt and water, on to th eskin somewhere near the spot to be destroyed .

Over i t was placed some oiled silk~or waterproofstrapping. The z inc point was then thru st throughthe fungating mass to be d estroyed a small shieldof gutta-percha, or cork, reg ulated the z inc poin t.Some cotton-wool and a bandage were placed overall . The gland was gradually disintegrated by theformation of chloride ofz inc at the expense ofthemetal inserted, and came away in four to six days.When all the gland had come away

,th e wound

Spencer Well s was employing this method for theremoval 'ofu terine cancer. He referred to twocases, in which, though the results were very satisfactory

,much pain was complained of. In the

latter, the total weigh t of slough wasfour hundredand th irty-th ree grains. He narrated the history ofone case in which he applied the z inc in the formof a flat disc to necrosed bone with good resul t.B r i tis/z M ed i cal

_

‘

7 0urnai .

AGENC Y OFWHITE CORPUS C LES IN THE COAGU LATION OFTHE BLOOD — Professor Schmidt hasshown us that there is no fibrine in the circulatingblood, and that th e fibrine ofthe clot is representedby the fibrinop lastin and fibr inogen Of the liquorsangu in is . Later i t appeared that, in order thatthese factors should unite

,i t was necessary that a.

th ird subs tance should be presen t. This th irdsubstance has been traced to the white bloodcorpuscles bu t in order that i t may act in producing fibrine i t must be set free by the disintegrationof these corpuscles.What are the reasons for bel ieving that the wh i te

blood corpuscles contain the ferment necessary tocoagulation ofblood? These are wel l stated byDr. Burden Sanderson in the B r i tt

'

s/z M ed ical

January 1 2th,1 8 78. F irst, he shows

that certain wh ite blood corpuscles disintegrate fromthe moment they leave the blood stream . The

experimental proof ofth is i s as follows : Bloodfrom an artery or vein is caught in a tal l j ar in wh ichi t is rapidly cooled.

‘The jar is now surroundedby ice, the blood remains uncoagulated, the redblood d iscs s ink to the bottom

,th e white ones ris e

to the tOp, and serum separates the two. I f thecolorless l iquid at the top be collected with apipette, almost immediately i t wil l be found to contain numberless colorless corpuscles and if theobservation be continued it is seen that a certainnumber of the leucocytes rapidly undergo d is integration. I n the process Of disintegration thecorpuscle breaks up in to granu les, which hold together for a t ime in the l iquid

,but eventual ly dis

appear. Prof. Schmidt has s een th e first fo rmedfi laments ofthe fibrine originate from the heaps ofgranular debr i s which the corpuscles leave behind .

them. Further,i f the wh ite blood corpuscles be

withdrawn coagulation is arrested . Proof of thisi s rendered possible by the fact that leucocytes, atthe temperature offreez ing

,acquire such firmness

and consistence that they are held back by theordinary method offi l t ration. This being the case ,the physiologist can Obtain uncoagulated plasmafree from leucocytes. The fi l trate thus Obtained isabsolu tely transparent and deprived Ofi ts power ofcoagulation. Ifnow -we wash the white blood cor

puscles collected on the paper fi l ter and add themrapid lyclosed ,with very little scar. The l in t must be to the decorpusculated plasma, the latte r is; restoredwetted wi th salt and water, n ight and morning. Mr. to its original coagulabil ity.

— D etroi t Lancet.

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THE C ANADA LANCET.

DELAYED L IGATURE OFTHE FUN I S .— Dr. Budin

,

while interne at the Maternité, came to the con

e lusionfrom his investigations that i t i s better not tot ie the funis t ill one or two minu tes after th e com ~

plete cessation of the pulsation . By tying i timmediately after birth we in fact preven t the childderiving about n inety-two grammes ofblood fromthe placenta. Now, as Welcker, Bischoff, ando thers have shown that

“

th e weight ofthe blood ofa new-born infant amounts on a mean to 2 70

grammes,or abou t a th irteenth part ofthe weight

of the body,abstracting n inety-two grammes may

be considered as equ ivalent to bleeding an adul tofthe weight of sixty-five kilogrammes to the extentof grammes . Dr. Hélot, Surgeon to theHosp ice at R ouen

,has since examined the subj ect

wi th the intention Ofshowing whether the infantreally acquires this blood

,by counting the globules

ofblood by Hayem ’ s method and by weighing theinfant immediately after birth before dividing thecord, and then again when the cord has ceased tobeat. By these means he found that there was anin crease of globules

,and an addition to

the weigh t ofthe child of fifty-three grammes. Hetherefore thinks that in normal cases rapid ligatureOf the cord should be entirely rej ected

,th is opera

t ion not being performed til l some instants afterrespiration has been completely establ ished.

London Med . l imes and G az .,from G az . des H op .

PURE D IALYS ED IRON . A year since,when

Dialysed Iron was a novel ty, I commended i t inthe New s

, as a most valuable addition to theMateria Medica. Twelve months of additional experience have confirmed my faith in its excellence.The obj ect ofth is note is to cal l attention to thegreat variety ofspur ious preparations sold under thename ofDialysed Iron . In this city I have foundn ine varieties ofso-cal led D ialysed Iron . Some ofthese were manufactured here

,bu t most ofthem

where made elsewhere. Genu ine Dialysed Iron isnearly tasteless. I t has the faintest possible sal ineflavor and a mere suspicion ofroughness. Slightlydilu ted, its taste recalls that offresh blood. I t isnot in the least unpleasant

,and does no t blacken

the teeth or tongue . I t seldom or never producesany gastric disturbance or headache, and veryrarely constipation. I t is exceedingly rel iable andrapid as a tonic.

The spur ious forms ofthis drug are withoutthe characteristics oftaste and efficacy aboveenumerated, and chemical analysis readily detectstheir deficiencies. One ofthe spurious specimensbefore alluded to , was l i ttle less unpleasant thanthe tincture ofmuriate ofiron , another wasexcess ively acid , another was decidedly sal ine,another was exceed ingly astringent

,another was

sweetish , another was bitter, and another was

My attention was firs t d irected to this matterthrough the failure or m isbehavior ofth e DialysedIron in practice. I t i s but j ust to say that thegood specimen is from Wyeth Brother, theoriginal manufacturers ofth is medicine in America.

Wyeth ’s Dialysed Iron sells at about a dollar apound. O ther makes may be bought at fifty cents.”

-Dr . L. P . Yandell,Louisvi lle, Med . New s .

TREATMENT OFENLARGED PROSTATE. —~Ithas been found desirable in the Dispensary praetice to adopt a method oftreatment for enlargedprostate

,obviating the use ofany instrument, as

the patients are usual ly unable to buy one. Acertain amount of rel ief is obtained by the fluidextract ofbuchu or oftriticum repens, when thesecretion is turbid or acrid ; but their effi cacy isofcourse , sl igh t when unaccompanied by the introduction ofth e soft catheter. I t was my goodfortune to try the effect ofthe fluid -extract ofergotin large dosesfor those cases, and was tempted todo so by the success I Obtained from it, in treatinga case of simple incontinence without enlargedprostate . The treatment proved successful , and isnow a standard one with i ts in the surgical department. The following case will i llustrate the wayin which it actedW. M . , aged twenty, laborer, came to the Dis

pensary May 1 0,1 8 76 . He stated thatfor some

1 0 or 1 1 years he had suffered from dribbling ofurine . On May 3rd h is troubles were much ag

gravated , and he camefor rel ief. A catheter wasintroduced

,rel ieving his bladder. The patient

was then at once pu t upon the fluid-extract ofergotin tea-spoonful doses

,to be taken three times a

day. Previously he had passed water with extremepain and diffi culty seven or eight t imes a day, andfrom four to five times at night. He experiencedgreat rel ief from the ergot .May 23rd

— H e reported that h is water was nowpassed only five t imes a day

,and tv

'

vice at night.The water is clear

,and there is l ittl e pain in pass

ing i t. In cases where the patien t can buy thesoft

,elastic catheter (Nelaton

’

s) , i t i s recom

mended,with d irections to use i t twice or three

times daily. This treatment may be combinedwith the use ofergot bu t ergot alone has beenfound ofgreat advantage

,the patients returning at

regular intervals to have their medicin es renewed.

— D r . S atter tlzwai te’

s IV. I’fMed . y ournal .

A DEL ICATE MED ICAL QUESTION .~ A ‘etter from

Paris recites th is event — A young widow, whoseaged husband had died

,becomingly appeared two

months afterward at the Paris Marie, to announceher forthcoming marriage to her cousin . Pardonme

,madame,

” Observed the clerk,“ bu t the law

peremptorily forbids a woman to marry with in tenmonths Of her husband’s death .

” Yes, truly,”

seemingly only colored water ; another’

more nearly repl ied she, but are not those eight months ofapproached correctness

,but only a s ingle specimen paralysis to be taken into cons ideration

possessed the peculiarities ofthe true article .

THE CANADA LANCET.

THE CANADA LANCET.

AMonthly Journal ofMedi cal and Surgi cal Sci enceIs sued Promp t ly on th eFi r st ofeach Month .

fl“C om m u n i ca t i o n s s ol ic i ted on a l l M ed i ca l a nd S ci

en t ifi c s u bj ects , a n d a l s o R ep or ts 0 C a s e s occu r r i n g i n

p r a c t i ce . A d ver ti s em en ts i n s er t s o n the m os t l i be r a l

ter m s . Al l L e t ter s a n d C om m u n i ca t i on s to b e a d d r es s ed

to th e “ Ed i tor C a n a d a L a n ce t ,” flor on to .

AGENTS .-DAWS ON Baos Mon t real ; J . a A. MCMILLAN ,

S t . John ,

N.B . ; J . M. BALDW IN,805 Broadway , New York, and BALLIER E,

pox‘

TINDALI. & C ox,20K ing W i ll iam s t reet , S trand , London , England .

TOR ONTO, JU LY 1

,1 8 78.

MOR TALITY AMONG CHILDR EN .

.From the mortal ity retu rns ofthe Boards ofHeal th ofcities in th is coun try i t appears thatabou t 40 per cent. ofal l the ch ildren born , die

d uring th e firs t year; that 20 per cent. die before

the fifth year, and that 65 to 70 per cent. die beforeth e tenth year

,or more than hal f ofal l th e children

born are dead before the endofth e r s t decade Such

frightful mortal ity among th e young ofth e humanrace must surely be due to some expl icable cause,o r causes

,for among the young ofno animal ,

n ative or domestic,i s the mortality amongst the

young so great.

I f we refer to the tables ofmortal ity in Englan d we will find that i t has been estimated that

out of ch ildren born al ive,I only

,or

a l ittle less than one-seventh have died during the

fi rs t year; in the second year,or 1 4 7 , and

'

by the end ofth e sth year nearly or up.wards ofi , have perished. During the next five

y ears the children are left more to themselves ,exercise more

,and although during these years

,

t hey run the gauntlet ofmost infantil e diseases asmeasles

,scarlatina

,whooping cough

, &c. yet only

d ie during th is period and so on,l ess during

eac h successive year up to I 5 , when i t begins to

increase . In Montreal , th e mortallty among infan tshas been excessively large , as compared with anyo ther c ity in the world

,and the Heal th Offi cer,

-Dr. Larocque, finds i t necessary to apologiz e for

t h is , by referring to the fact ofthe large birth-ratewhich , owing to the prol ific character ofth e Frenchp ortion ofthe population , -i s greatly in excess ofany other ci ty. The infant mortal ity has al so been'very great in Toronto and other large cities .We will here quote fro in the elaborate report of

‘

Dr. Larocque, to‘ confine ourselves to publ ished

facts,and figures

,where we find that the total

death rate ofthe City ofMontreal during 1 87 6

was an increase of229 over that of1 87 5 .

The greatest mortal ity rate occurred during J uly

and Augu st,owing to th e meteorological state of

th e atmosphere promoting d iarhoeal diseases among

infants , while in September the mortal ity rate con

tinued h igh,owing to the prevalence ofsmall

The following compari son ofdeath rate betweenMontreal and other large cities is given in the t e

port : I n Montreal the death rate under I year

was per cen t.,under 5 years 6 2 per cent ;

In New York ( 1 867 to under 1 year was

per cent. , under 5 years 50 per cent ; in C in

cinnati ( 1 86 7 to under I year was per

cent., under 5 years per cent ; in C leveland

under 1 year was 3 7 per cent. , under 5years 54 per cent ; i n Boston under 1 year was

per cent.,and under 5 years per cent

in Philadelph ia under 1 year was

per cent.,and under 5 years per cent.

In Montreal th e birth rate i s per ofpopulation ; i n Philadelph ia, per in

Boston,

per in Cleveland , per

in New York, 24 per Boston has

the highest quoted ; but that ofMontreal exceedsi t by per

The report says very tersely and forcibly,The

total number ofdeaths among ch ildren , under1 0 years ofage , d uring th e year, was threethousand and ninety-seven

,giving a percentage of

to total mortal ity ; under 5 years per

cent. Over one-th ird ofth e annual number

of deaths occu rred among children under 1 year,

more than one-hal f under 5 years, and two

thirds under 1 0 years. Small-pox,meas l es

,

diph theria and scar la tina, to wh ich we owe theexcess ofmortal ity under 1 0 years ,

'

cause com

paratively few deaths among children under 1 year,the excess during tha t period be ing d ue more

especially to infantile debil ity and diarrhoeal dis

eases.”

Further the report as cribes to d iarrhoea,dysentery

and cholera infantum 658 death s among ch ildren

under 1 0 years of age , 456 ofwhich were under 1year, and these d iseases were almost wholly confined to

'

the th ird quarter. “ The highest mortal ity

occurred among the French-Canadians. '

.Mostly

THE CANADA LANCET.

all the deaths occu rred under 1 year,and from 1

to 5 years, and the high death rate is ascribed

chiefly to the excess ive heat ofsummer and improper alimentation among the poorer classes.”

From convulsions there are recorded 1 2 2 deaths,and most ofthese occurred from errors in diet. Thefour d iseases accounting for the greatest number ofdeaths respectively were as fol lows in their order as

they stand : Infan til e debil ity, under 1 year, 435;under 5 years, 50 under 1 0 years , 3 from

diarrhoea, under 1 year, 230 ; under 5 years , 5 5 ,and under 1 0 years

,1 ; from cholera infantum ,

under 1 year,204 ; under 5 years, 33 , and under

1 0 years, 3 ; from small-pox (not necessarily an

infantile disease) , under 1 year, 1 60 under 5 years,

36 7 under 1 0 years, 7 7 .

Estimating the population at the death

rate is per cent. or per while

the excess ofdeath rate among children , under 1 0years of age

,in Montreal is 1 3 per over

Philadelphia and per over Boston— or

estimated, according to Dr.Fatr's valuation ofhuman l ife of from 1 to 5 years $225 — the annual

loss over,BostOII in money value i n children is

per annum , and over Ph iladelphia

per annum the average value ofl ife, according toFarr

,being for a child , under 1 year ofage

, $20

from 1 to 5 years $225 , at 1 0 years $46 1 , at 20

years $936, at 2 5 years $984, at 55 years $5 5 2 .

Now if we add to the annual loss by death samong ch ildren actually born

,an additional num

ber, say on e-fourth as many more that have never

been allowed to be born , by the ndw fangled notions

respecting the prevention ofconception,in defence

ofwhich these people argue that an excess of

In regard to the general cry of,unheal th iness of

cities,the thousands of h eal thy children teeming

th e numerou s publ ic' schools attest the contrary,

where there i s not homicidal nursing, or bad

management ofthe children at home. What may

be presumed to be the reason ofthe high mortal ityrate in al l foundling insti tu tion s

,over that of

private nursing,but the difference in the manner of

feeding— that is between natural and art ificial nurs

ing ; therefore, we take it that in ci ties al l chil

dren starting on equally fair condition s from birth ,with the same nursing and home management,should have equally the same chances ofl iving, orexpectation ofl ife, l eaving aside the chances ofdeath arising from the danger incurred to al l in

running the gauntlets ofch ildren ’s diseases , whichto many

,may be rated among the accidents of l ife.

PHYSICAL CULTUR E .

An exchange has an articl e from wh ich we take

a few extracts, on th e

‘

“ Limits ofPhysical Culture”which is well worthy the consideration ofmembersof the profession . We can recall several instances

during our own experience in practice in which

cardiac affections were directly attributed to viol en t or excessive bodily effort. On e notable ins tance ofaort ic valvular disease of the heart in ayoung man ofgiant proportions is a remarkably

direct case ofinj ury to th is organ from the overexertio n ofhard rowing, and the sudden death ofthe English oarsman during the race with the St.

John ’s crew,is ano ther instance ofthe danger of

excess ive exertion .

“ We have frequently had occasion to dwell

population always means an excess of pauperism,upon th e fact that

,while moderate physical

it represen ts amon eyvalueoflargeamount . Parents culture is a great ben efi t— indeed a necessity, to

constantly raise the cry against the city, ofbad insure a proper balance of mental and bodily

drainage, &C ., al l true enough to a certain degree , powers, and consequent health and longevity

entirely overlooking th e errors in nurs ing and physical over-cul ture is a great evil , l eading to 16

private management ofinfants, by wh ich , in th e sults diametrically opposite to those sought to be

matter of diet alone,an enormous amount ofattained. At one end ofthe series i s a constitu

mortality, is occasioned among the l ittle ones. tion ,weak,and unfitted to resist disease or the effectsIndeed, so gross is the ignorance , neglect or care of labor

,on the other an organization strained to

l essness often manifested in the care of infants, too its utmost and ready to yield u nder the sligh testoften left as they are, almost entirely to the charge addition to the stress. Obviously between theseof an ignorant nurse

,or to the care ofth e older extremes there must be a mean , up to which all

“

children— that ‘th e mortal ity rate among infants can cul ture is beneficial,and beyond which all is over

scarcely be wondered at . cul ture. The question is,whether that mean i s

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THE CANADA LANCET.

R EM EDYFO R PO IS ONs .— It is stated by an

American exchange that sweet o il introduced intothe stomach is a n eutraliz er ofal l poisons ofanacrid or corros ive character. The remedy is harmless

,nearly always at hand

,and is worthy ofa

OWNER WANTED — We rece ived from a sub

scriber,by post

,on the 5 th ult., the sum ofsix

dol lars in payment ofsubscript ion to the Lancet,As no name was attached to the enclosed sl ip we

are at a loss to know from whom i t was received.

The money is perfectly safe,but we owe somebody

a receipt for i t.

SC IRRHUS CANC ER OFTHE BREAST IN THEMALE. -Mr. Chris topher Heath, ofUniversi tyCollege

,London

,reports in the London Lancet , a

case of scirrhus ofth e breast i n the male . The

patien t was about 47 years ofage, ofheal thyparentage

,and no family history ofcancer. He

first noticed it four years ago. He attributed his

disease to a habit he had of striking his hand

against h is chest. The cancer was removed and

also some enlarged glands in the axilla.

LONGEV ITY.— The average of human l ife is aboutthirty-three years . One quarter die before th e ageofseven . Of every one thousand persons, one

rarely reaches the age ofon e hundred years,and

not more than one in a hundred will reach the age

ofeighty. There are on the earth

inhabitants. O f these about die every

year ; die every day, every hour,and

sixty every minute . The married are longer-l ived

than the single. Tall men l ive longer than short

ones

BR ITI S H DIPLOMAs .— The following gentlemen

have successfully passed the required examination,

and were admitted to membership in the R oyalCollege ofSurgeons

,England

,in May las t —D.

H . Dowsley, M . D.,ofClinton

,and G. T.

McKeough, M D ., (Trinity College) of Chatham .

The following gentlemen have also passed theexamination at Edinburgh for the double qualification Edin z— J. E. Eakins

,

M .D . , ofNewburgh ; A. E. Mallory,M .

D.

,Of Cobourg ; W. D . R obertson

,M .D .

,of

Montreal, and A. T. Somervi l le,M .D.

,of New

Brunswick.

BRAIN HYG EINE.— The brain that i s not habitu

ated to s teady hard work , i s l iable to be more orless inj ured by any spasmodic strain. In a heal thy

cond ition,however

,suppl ied by pure blood , ‘ so as

to insure th e true balance between destruction and

repair,th e organ wi ll bear almost any amount of

tasking. So long as an intel lectual worker can

sleep,eat and exercise fairly, he is master of

th e situation and the number of hours he devotes

to his labors i s much at h is option . When sleep

becomes fi tfu l and disturbed, and appeti te fails, l eth im beware to persis t in labor despite these warn

ings is to unsettle the system and either suddenly

or gradually to break i t down. Where there are

extra cares and worries,whether connected with th e

daily occupation or otherwise,the diffi culty offul

fi l l ing the conditions of a heal thy brain is increased

tenfold.

A LADY WITH Two H EADs .—As will appear

from th e following notice in the daily press,th e

double headed ch ild,noticed in a previous issue is

not al together unprecedented. Th e Two-headed

Nightingale,” i s with other interesting specimens of

humanity, to give a series of entertainments in

Alloa, Scotland, early in Apri l. This lady possesses two heads on on e body, with two chests and

four arms. Such combinations of foetal develop~

ment as these cases illustrate ar e diffi cul t of explanation , and only serve to show how l ittl e we

really know ofthe mysteries ofnature’s operat ions.THE H OMCEOPATH S IN D IFF IC ULTY. The

members ofth e New York Homoeopath ic Society,

have lately discovered that they are l iable for

damages at law,if th ey swerve from the practice

ofth e principles which they publ icly profess.According to high l egal authority

,which has been

confirmed by the Opinion of Judge Davis, ofthe

sepreme court ofth e United States,when a

physicran undertakes to treat according to the

principles and practice ofany particular system,he

must conform to that system in his treatment , anda failure to do so would be a violation ofhis contract, so impl ied by the law,

and he would be held

responsible for such violation . I t is therefore proposed to so alter the Constitution of the Society,as to make it legalfor th em to practice on

system . This seems like lowering the homoeopathicflag.

THE CANADA LANCET.

R OYAL COLLEGE OFSUR GEONS . i r Joseph

Fayer,Mr. O l iver Pemberton , and Dr. Norman

C hevers are among newly-elected Fel lows.CAS CARA SAG R ADo.

—This is reputed to be th e

best remedy for chronic constipation ofth e bowelsyet discovered. The dose is from a teaspoonful to a

tablespoonful ofth e fluid extract , three times a day.I t is prepared by Parke Davis C O . ,

Manufacturing chemists

,Detroit.

PAPER L INT.— This substance which is now

being introduced and u sed instead of ordinary l in t

po ssesses some most excel len t features. I t is

lighter,cheaper

,and as an absorbent, far superior

to cotton or l inen . I t can be readily impregnatedwi th carbol ic acid, sal icyl ic ‘ acid, thymol or other

an tiseptics,and used wet or dry.

A MONUMENT To CLAUDE BER NAR B .— The

Paris Société de Biologie has appointed a com

m i ttee to sol ici t subscription s for the erection ofasu itable monument to perpetuate the memory ofthe illustrious savan t

, ofwhom the whole Frenchnation is j ustly proud.

gammaofmasti t is.M I C H IGAN STATE BOARD OFHEALTH .

The regular annual meeting ofthis Board washeld at Lan sing, Tuesday, April, 9th, 1 8 7 8 , th e

following members being present : Dr. R . C .

Kedz ie,President

,Hon . Le R oy Parker, R ev. D.

C . Jacokes, and Henry B . Baker, Secretary.I t being the annual meeting, Presiden t Kedz ie ,

presented h is annual address, ent i tled“ The

Work ofthe State Board of Health ,” in which h egave an account of th e past work ofth e Board ,and ou tlined i ts work for th e immediate future.

Among the many duties wh ich the Board had per

formed sin ce its organ ization , about the firs t effortwas for th e establ ishmen t ofwell organiz ed andeffective Boards ofHealth , in every township , city,and village throughout the State, securing th e ap

pointmen t ofa Heal th Offi cer, by every Board ofHeal th

,and then bringing the State Board of

Heal th in to commun ication and active co-operation

with all these local Boards ofHealth , thus gainingtwo important obj ects ; ( 1 ) having an effective

343

channel for imparting information, ( 2) having

organiz ed bodies through which the statistics inregard to publ ic heal th could be gathered from all

parts ofthe State. Besides th is the Board had

secured the as is tance ofmany physicians throughout th e State , receiving from them many valuable

reports, communications , and repl ies to circularsregarding the cause and progress of various diseases.He referred to th e general plan ofwork with in theBoard , by distribu ting the d uties to regular com

m ittees on d ifferent subj ects, and claimed that everyState Board ofHeal th subsequently organiz ed

,had

approved ofth e plan by adopting it. In speakingofth e efforts to impart information , and gathe rstatistics bearing on the publ ic heal th

,he said the

resul ts were most gratifying. Nor only sanitarian s,

but th e people at large, are grasping that very importan t and revolutionary idea , th e pos ibi li ty oftheprevention ofdisease and death ; that many diseasesmay be prevented altogether

,or that when they do

appear,they may as certainly be stamped out as a

fores t fire may be extinguished, or they may bewalled in l ike an inundation . A people who fullygrasp th e idea that half of their sickness and deathmay be avoided , as truly and really as they may

prevent th e destruction ofth eir crops by cattl e, by

proper fencing, have taken a long stride in s tate

medicine. This fact ough t no t to be los t sigh t of,

that each person is in the broadest and fullest sense

healthy and safe only as every person about h im isheal thy and safe. I n outl in ing th e future work ofth e Board , th e Doctor said that th e law now saystha t the Board shal l from time to time recommend

standard works on hygiene, to be used as tex tbooks in our common school s. He recogniz ed thefact that public h ealth measures , have theirfoundat ion on vital statistics, and i t becomes th erefore a

matter of necessity as wel l as oflaw that we should:study these records , in order to promote th e heal thand safetyofth e people. In h is Opin ion the questionoffood and its preparations for human use

,has .

more vital relations to the publ ic health and wel

fare than al l oth er physical causes combined. I f

our people can be taugh t to p reserve and prepareth eir food so as to secure th e best dietetic results

,

preventive med icine '

wi ll have won a grand victory . .

I t could then no longer be said , that our ap

prOpriate monument would be a frying-pan and ourepitaph saleratus.”

Dr. Baker made a report of the work done in

THE CANADA LANCET.

the office during the quarter just ended. Blanksand circulars ofins truction for annual reports ofhealth offi cers and clerks oflocal boards ofheal thhad been sent out, and documents of th is

kind had been received,examined and fi led. Dr.

Kedz ie was asked to attend the mee ting oftheAmerican social science association at C incinnatiMay 1 8 to 24 and Dr. Baker was asked to attend

the coming meeting ofthe American publ ic healthassociation .

ONTAR IO MEDICAL COUNCIL.

M INUTES AND PROC EED INGS .

The Council of the College ofPhysician s andSurgeons ofOntario met in Toronto on th e 1 1 th

ult. Dr. Daniel Clarke , President in the chair. Them inutes ofthe previous meeting were read, andconfirmed.

The fol lowing new members took their seats ;Dr . W. L. Herriman , and Dr. E . M. Spragge inthe place ofDrs. Dewar and Hodder deceased .

The President then del ivered h is retiring address.After thanking them for the support they hadawarded him during the past year

,he said i t was

w i th great sorrow he had to report the decease ofDr. Dewar and Dr. Hodder. He paid a feelingtribute to th e high profess ional standing ofDr.Dewar

,and made an acknowledgement ofthe ser

vices he had rendered the Counci l . The name ofthe late Dr. Hodder was famil iar wherever medicall iterature had a place

,and his loss would be keenlyfel t by the profession and the Council. He then

referred to the necess ity of providing a suitablebuilding for exam ining students th is year

,the U n i

versity Convocation Hall having proved to smal lfor the purpose,and suggested that the building in

the Queen ’s Park at present occupied by the R egi strar should be fi tted upfor the purpose, or that ap iece ofproperty should be purchased in a centralpart ofthe city and a suitable registrar’s office andexam inat ion hal l erected thereon . He reported NOTIC ES OFMOTION'that about eighty quacks had been prosecuted duri ng th e year, and whil e on this point alluded to theremark made by Dr. H ingston

,in an address be

fore the Canada .Medical Association,to the effect

that Dr. Jenks, ofDetroit , had been threatenedw ith prosecutionfor pract ising medicine on theCanada side ofthe l ine . His explanation was thatwhile the Ontario Medical Council did not Obj ectto dist inguished men from the States com ing over toconsul t w i th Canadians

,i t was bu t doing j ustice to

our own medical men practising along thefrontierto refuse to perm i t Americans to take patients oftheir own in C anada, un less they took out a l icensehere and passed the regular examination . He had S EC OND DAY 5 PROC EED INGS :

endeavoured to have the penal clauses ofth e Act The Council met at 10 o’clock , th e President inthe chair.

enforced in all ins tances except in the case ofgraduates who gave val id reasonfor not taking outa l icense last year. The representatives oftheCouncil had introduced into the Legislature amendments to the Medical Act, but, although they werein principle approved by both s ides of the House,they were not passed, owing to the lateness ofthe irintroduction. He suggested that the Councilmight

,out oftheir surplus funds , establ ish three

bursaries of$20, $40 and $60, for competi tion bymed ical students.After a vote ofthanks to the retir

'

ng pres identDr. Campbel l was elected president or the ensuing year and Dr. All ison vice-pres ident.

The PRES IDENT elect, in returning thanks, saidthat he fel t great pleasure at h is election , not frommotives ofgratified ambition , bu t because theCouncil had don e an act ofj us tice. He

,had al

ways worked hard in the interests ofth e Council,

and not in the interests ofa part icular School .He assured them

’

that this impartial ity he wouldstil l maintain in his pos ition as President.

STAND ING C OMM ITTEES .

The Committee appointed to d raft StandingCommittees for the year reported as follows

,which

was adopted— Drs . Bethune , Bogart, Henwood,

Lynn,Vernon

,Spragge.

P r i n ting— Drs. Cornell, Carson, Macdonald,

Morden , Muir, Lynn.Fi nance — Drs. Hyde, Herriman , Henderson,I rwin

,R oss .

R ules and R egulafious .—Drs . Brouse

,W. Clarke,Berryman

,D . Clark

,Bogart, Edwards.

Ea’ueal iou .

— Drs. Brouse,Aikins

,Berryman

,

Ge ikie,Wm . Clarke, Edwards , Grant, Lavell ,

Logan, MacLaughl in , Morrison , D . Clark.

S everal commun ications and peti tions frommedical students and others

,were received and re

ferred to the respect i ve Comm i ttees.

Dr. Allison- To ratify the by-law regulat ing theproceed ings ofth e Counci l , as adopted by theExecut ive

,leaving i t open to any member to offer

amendments during the present session .

Also,that all appointments to the offi ce ofmedi

cal examiner be made among members ofthe profess ion outs ide the Council .Dr. Campbell— Three resolution s upon recipro

city ofregistration with the General MedicalCounci l of Great Britain .

The Council then adjourned.

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346 THE CANADA LANCET.

the matter his serious consideration,and to consul t

with the Senate ofthe Universi ty about the proposal .

Dr. BROUS E , seconded by Dr. GRANT, movedThat in the Opin ion of this C ounci l the t ime has

arrived to secure a permanen t buildingfor it s u se,

that a Committee be appointed to take the necessarystepsfor such , and that any arrangement the Comm i ttee may make shal l be bind ing on the Council ;the Committee to consist ofDrs. All ison

,Aikins

,

D. Clark, W. Clarke, R oss, Berryman , and thePresiden t.

Dr. HENWOOD presented a statement containinga schedule offees to be charged in the counties ofBrant and Hald imand referred to the R egistrat ionCommittee.

Dr.McLAU G HLINpresented the report of the HighSchool Committee appointed to consider the advisab ili tyofadopting the in termed iate exam ination in lieuofthe matriculation examination . The report, whichrecommended the Council not to make the proposed change, was adopted .

A number ofaccounts were presented and re

ferred to the vari ous committees,after which the

C ouncil adjourned .

THIRD DAY’S PROC EEDINGS .

The Council met at ten o ’clock.

Dr. BETHUNE,on behalf ofth e R egistration

C ommittee, presented a report, which was adopted, recommending that the tariff of fees for thec ounties ofBrant and Hald imand be adopted ;that the requests ofS . G. R ob inson

, J . B. Baldwin

,and J . S . Campbell for permission to practice

he not granted, as contrary to the Medical Act ;that the case ofDr. Bomberry, an Indian ,

and agraduate ofMcG ill College, who des ired registration in Ontario

,receive the favourable cons idera

t ion of the Council,that Dr. Mallory’s requestfor registration be not granted unt i l he comply

with the requ i rements ofth e Med ical Act,that

Dr. Drummond ofJamaica,West Ind ies

,wlio ap

pl ied for registration i n the Domin ion under amisapprehension ofthe terms ofth e Medical Act

,

be commun icated with by the R egistrar,and befurn ished wtth a copy ofth e Medical Act ; and

that the report ofth e Publ ic Prosecutor be referred to the Finance Committee.The Council went into Committee on th e report

-ou Dr. Bomberry’

s case.Dr. BETHUNE explained that the Dr. only desired

to practice among the Indians,and that he desired

to be protectedfrom prosecut ion . He had beenp revented from attending the last examinationby illness.

On motion , i t was agreed that Dr. Bomberryb e granted a special exam ination .

At a subsequent s itting it was recommended that

Drs. R yerson , NevItt Comfort, and Chaffey be alsoallowed a special exaimination at the same time. a

The PRES IDENT stated that he had received aletter from the R egis trar ofth e General MedicalCouncil ofGreat Britain , embodying a copy ofthe minutes ofthat Council , a copy ofth e Bri tishMed ical Act

,and other documents. He inferred

from the communica tion that the British Councilwould be quite ready to interchange registrationwith Canada. The communication was referredto the R egistration Committee.

The PRES IDENT, having left the chair, moved aseries ofresolut i ons regardrng reciprocity In med ical registratron .

1 . R esolved— That the President ofthe CollegeofPhy si cians and Surgeons of Ontario be autho

r ized to inform the R eg i strar ofthe general Medical Council ofGreat Britain that h is certificate ofregistration to practice both medicine and surgeryin Great Britain will be accepted by the Councilofthe College of Physicians and Surgeons ofOntario

,as constituting a suffi c ient title to registra

tion in the Ontario Med ical R egister whenever theR egistrar ofthe General Medical Council ofGreatBritain notifies our R egistrar that he is preparedto accept the certificate ofregistration in theMedical R egis ter ofOntario as a s uffi cien t titl e toregistration in both medic ine and surgery in theMedical R egister ofGreat Britain ; and that suchregistration shall be allowed In Great Britain uponth e same terms ofpayment as requ i red In Ontario,namely

,two pounds sterl ing.

2 . R esolved— That the Council ofth e CollegeofPhysicians and Surgeons ofOntario recogniz ethe force ofthe principle enunciated by theMedical Acts Committee ofthe General Medical Council ofGreat Britain , that whilefreedomofchoice as to places ofstudy ought to be Opento all

,the Committee would think i t inadmissible

that British students,in tending to practice i n the

Uni ted Kingdom,should have the option of

undergoing i n any other country than their ownthe exam inations which are to test their fi tnessforpractice therefore

,applying the same pr inciple

to Ontario students as is applied by the GeneralMed Ical Council of Great Britain to British students, the Council ofthe College ofPhysiciansand Surgeons ofOntario consider i t inadmissablethat Ontario students

,intending to practice in

O ntario,should have the option ofundergoing in

any other country than the ir own the examinationswhich are to test their fi tnessfor practice, and thatthe recogn ition of registration in the Bri tish Medical R egister shall not be held to exempt from theexaminations establ ished by the Council oftheCollege ofPhysicians and Surgeons ofOntarioany on e who had begun his med ical studies at anyofthe medical schools in Ontario, or who couldhave been properly considered as a resident in

THE CANADA LANCET.

O ntario before the commencement ofh is medi cal3 . That all such students from Ontario as are

referred to in the foregoing resolution , shal l be required to pass at least the “ final ” exam ination ofth is Council

,and shal l pay the usual examinat ion

fees therefor.

4. That the President be authoriz ed to requestthe Directors General ofthe Army and NavyMedical Departmen t ofGreat Britain to recognizeregistration as a member ofthe College of Physie i au s and surgeons ofOntario as constitu t i ng asuffi cien t qual ification for candidates to presentthemselves for examination as surgeo ns beforetheir respective Medical Boards.After some discussion i t was decided to leave

the matter over un ti lO

the passing of the BritishMedical Act .Dr. DAN I EL CLARK moved , That no registration

ofpersons alleging to have been practitionersbefore 1 8 50 shall be permitted to take place untilth e credential s ofsuch appl icants have been exam ined by the Council or Executive Committee ,and the sanct ion to register given by the same tothe R egistrar.

At one o ’clock several ofthe members oftheCouncil drove -to th e General Hospital , and werereceived by Dr. O ’

R ei lly, the resident m edicaloffi cer of the institut ion . His Worship th e Mayorwas al so presen t. Dr. O ’

R eilly conducted the

m embers through the various wards, and al thoughtime did not permit of a cri tical and minute examination being made

,i t was generally conceded

by the professional gentlemen that the hospital wasin a satisfactory condition . The wards were cleanand well-ven tilated, perfectly free from offensiveeffluvia, th e bed l inen and all th e general appurtenances in excellen t order, and really a credit tothose who have the administrat ion of th e internalarrangements ofthe institution .

During the vi si t Dr . Aikins appl ied the galvan iccautery for th e removal ofa melanotic tumor, of asemi-malignant character from the region oftheumbil icus.

The Council re-assembled at 3 o’clock.

The question as the admission of graduates fromth e Province of Quebec came up for discussionnotably the case ofDr.Frecette, who sought to beadmitted by passing the final examination ofth eBoard in Ontario. I t was decided to refuse theapplication ofDr.Frecette, unless h e chooses tocomply with the terms ofthe Ontario Medical Act.Dr. GRANT th en moved, seconced by Dr. MC

LAU GHLIN,That i t i s the opin ion ofth e members of theCollege ofPhysicians and Surgeons ofOntariothat the matters pertaining to medical educationshould , asfar as po s sibl e , be reduced to one uni

form basis for the entire Dominion in order tos impl ify rules and regulations and set aside anyProvincial j ealousies wh ich may exist, and thusmake our profession a unit from th e Atlantic to thePacific also that in consul tations th e greates t poss ible lati tude should be extended to profess ionalgentlemen ofwel l recogniz ed abil ity in the neighbouring R epubl ic, thus exercising that knownl iberal ity wh ich is in keeping with the progress andscientific advancement of the presen t time .

He moved th e presen t resolu tion to place on

record h i s conviction that the best interests ofth emedical profession would be subserved by theformation ofa Dominion Board

,

” i n order tos impl ify the work ofthe profession . The best iaterests of the profession are now clashing, and difficulties exist which by a greater degree ofuniformity in medical matters migh t be very much benefited . The subj ect Of san itary sc i ence is nowunder th e same d ifficulty— medical and sanitarymatters are purely under the control ofthe LocalLegislatures . The powers gran ted by th e DominionAct are not to be disturbed without serious consideration , yet he fel t satisfied that if an expression ofopin ion emanated from th e whole body ofth e profession an influ ence for good In th e d irect ion indicated migh t be exercised. No doubt sometime must elapse prior to carry ing in to operation acentral medical examining body and sanitarybureau at O ttawa. The i nterests ofth e variousProvinces a re the interests ofth e Domin ion aswell , and such measures should be advocated aswil l at the same time simpl ify and strengthen theoperation ofmedical and san itary legislat ion.

Dr. ALL I S ON obj ected to th e terms ofth e resolu tion ,

as i t involved too much ofa free trade principi c

,and one h e did not th ink would act in a

satisfactory manner as applied to medicine .

After some discussion,Dr. A I K IN S moved, sec‘

onded by Dr. BERRYMAN .

“That th e considerationof the resolution be deferred for six months .”

Dr. CLARKE expressed his opinion that that wasthe best course to adopt.

Dr' BROUS E then poi nted out the importance ofestabl ishing a Bureau ofHeal th , and spoke ofth eefforts he had put forth in the House ofCommonstowards getting an appropriation for that . object.He thought Dr. Gran t deserved cred i t for bringingforward the resolu tion . The motion was lost.Dr. ALL IS ON moved, seconded by Dr. Mc

LAUGHL IN ,That wi th a vi ew ofl essening th e expenses of

th e Council and th e Executive Committee i t i sdeemed expedien t that not more than seven members ofthe Council do const itu te said Committee .Dr. EDWARDS moved in amendmen t, seconded

by BETHUNE, that the Executive Committee consistofnine members, two Of the n ine to be ex-ofia

’

o

members. The amendment was carried.

THE CANADA LANCET.

Dr. A IK INS moved , seconded by Dr. BROUS E,That Drs. Campbell

,All ison

,Daniel Clark

,Wm .

Clarke, Berryman , Macdonald , Aikins, Lavell andGeikie be members of the Executive Committee.Carried.

I t was moved by Dr. BERRYMAN,seconded by

Dr.,BROUS E,That the members ofth is Council having pro

ceeded to the Toronto General H ospital, in accordance with an invitation Of the House Surgeon

,Dr.

O’R eilly, would report by resolu tion— That they

found the wards and al l their appurtenances inmost excellen t and effi cient order

,the improved

condition ofvent ilation being remarkable. Whileexpress ing our deepest sympathy and heartfel t i hferes t in the general welfare ofsuch a valuable i hstitution , we , as a body corporate , would , by th isresolution , beg to express our thanks on behalf ofthe profession to the donating -Trustees and otherswho have so nobly assisted this institution

,and

further the efforts ofthose so kindly assisting havebeen so ably carried out by our present efficien tresident offi cer

,Dr. O ’

R eilly. This Council wouldat the same time earnestl y press on th e attent ionof the Ontario Governmen t the necessity oftheirimmediate or earl ies t assistance in such a noblework— by which an enactment as may to themseem best— for the rel ief ofthe poor

,th e sick

,and

distressed , thereby emulating the voluntary andhandsome donations ofprivate charity. Carried.

I t was moved by Dr. R oss,seconded by Dr.

CLARKE,That in the opin ion ofthis Counci l the time has

now arrived when the General Hospitals now inoperation in Ontario

,and such as shal l h ereafter be

established , should be placed upon a G overnmen talbasis s imilar to that provided for our Insane Asylums, so as to give an assurance to the sick poor inour midst that their wants and appl ications areduly respected , and also to equally distribute theonus ofthe ir support over the whol e community

,

and that we do earnestly recommend our profess ional brethren tht oughou t the whole country tourge upon the individual legislators

,and through

them upon the Legislature, the absolute n ecess i tywhich does exist for such provision being made.Carried.

FOURTH DAY’S PROC EED INGS .

The session opened at 1 0 o’clock.

Dr. GRANT, on behalf ofthe Special Committeeappointed to draft an address to Lord Dufferin

,on

the occasion ofhis departure from Canada , re

ported a form for adoption by the Council.The address was adOpted ,and on motion ordered

to be engrossed,and Drs . Grant and Brouse were

Dr. Logan on behalf ofth e Special Committee inthe case ofDr. Chaffey, recommended that h ebe allowed a special examination at any time before the Board ofExaminers . Carried.

Dr. A I KINS moved : That the following be theExamining Board , Dr. Clarke, surgery and surgicalpathology Dr. R oss, midwifery Dr. McLaughlin ,anatomy Dr. Morrison , chemistry Dr. MacDonald

,medicine Dr. Berryman

,materia medica ;

Dr. Edwards, physiology ; Dr. Logan , medicalj urisprudence. Carried.

Dr. CORNELL presented th e report ofthe Printing Comm i ttee. I t S imply recommended the payment ofsundry accounts, and was referred to th eCommittee on Finance.Dr. HYDE presented a report ofthe Finance

Committee. I t stated that the Committee hadfound the Treasurer’s book to correspcfid with thevouchers and that a balance of 8 1 stoodto th e cred it ofthe Council in the Canadian Bankof Commerce. The Committee was gratified toreport that the R egistrar had str ictly compl ied withthe instruction s given for h is guidance. He hadcollected on the assessmen t ofregistered practi

tioners only $28 1 , and the committee recommendedthat active steps be taken to collect the arrears .Mr. Wood, of Kingston , the matriculan t examiner,i t was reported

,was sti ll in arrears to the extent of

$225 9 7 , and the Committee recommended that thematriculation fees should be hereafter paid to th eTreasurer, and that the other accounts in connection with the examinations should be sen t directlyto h im . Several accounts were recommended tobe paid. Dr. Campbell’s accounts for preparingby

-laws,register

,annual announcement, &C .

,

amoun ting to $282 50, we also subm i t for yourconsiderat ion

,as we can find nothing in the

minutes of the Counc il, or the Executive C omm ittee, or any President

’s order,authoriz ing h im

to do the work. We are ofthe opinion that theabove is part ofthe duty ofthe R egistrar.The Council went in to Committee on the report,

and took up the d ifferent clauses ser i ’atim.

On the clause regarding the collection ofassessments

,some discussion took place as to Whether i t

was the duty of the R egistrar or the PublicProsecu tor to collect the money.

The item ofDr. Campbell ’s account, occasionedconsiderable discussion as it was alleged that theexpenses were incurred without the authority ofeither the Council

,Executive Committee, or the

President’s order.

Dr. W. CLARKE moved, seconded by Dr. D.

CLARK,that the report ofthe Finance Commi t tee

be amended by the payment of$ 1 70 to Dr.Campbell in l ieu of al l claims by him against the

appointed a deputat ion to present it to H is Ex Council , and th is i s paid as a testimony ofthecellency. services rendered by him to this Council . Carried,

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THE CANADA LANCET.

Dr.Wm . Clarke said that the sum of$ 1 70 was infull sat isfaction ofal l claims against the Council.Dr. Campbel l decl ined to accept the $ 1 70

granted h im . He had paid more than that out ofh is own pocket

,and he considered that h e should

be paid his ful l account. He fi rmly decl ined toaccept the money.

A vote ofthanks was passed to the Senate of th eUniversity ofToronto

,and Queen ’s College,

Kingston , for the accommodation afforded theCouncil.

On motion ofDr. Berryman,seconded by Dr.

Bethune,a vote Of thanks was passed to the Mayor

and Corporation for their kindness in allowing theCouncil the use ofthe City Hallfor i ts meetings ,and the President and Dr. Berryman were appointed a deputation to present the same at thenext meeting ofthe City Council .Dr. Aikins was again appointed Treasurer

,and

Dr. Pyne, R egistrar,for the curren t year.In regard to the salary ofth e R egistrar i t was

mentioned that the amount was inadequate to theduty performed , and suggested that be ap

propr iated instead of $7 50.

The R egistrar stated that on condition that anassistant be appointed to aid h im during the Exam ination s he would desire h is stipend to remain asheretofore .After disposing ofsome routin e business the

Council adjourned sm e a’z’

e.

C OUNTY OFBRANT MED ICAL AS S OC IATION.

A special meet ing Of the above Associat ion washeld in the Kerby House

,Brantford

,on Monday

June 1 6 th .

The members present were -Dr. Phil ip (President) , Burt, (Vice-President) , Harris, (SecretaryTreasurer), Dickson , Dee, D igby, Marquis, Clarke,Henwood, Sinclair, Griffi n , Corson , O '

R ei lly andH ealy.Dr. Griffin , m oved, Dr. Clarke, seconded, that

Dr. Dee be requested to prepare a paper for thenext regular meeting and that the consideration ofDr. S inclair’s paper be then taken up .

— Carried.

Dr. Griffi n moved,Dr. Marquis seconded, that

the Brant C 0. Medical Association are ofth eOpinion that the establ ishment ofa ProvincialMedical Association for Ontario with City andCountry branches, sim i lar to the State and CountyMed ical Associations in the United States

,would

be attended with many benefits to th e professionand to the publ ic, and express the hope that thein itiatory action taken recently by the Erie and

Niagara D ivis ional Assocration in the matter w il llead to the establishmen t ofsuch an Association— Carried.

£ 0035 mmEm itting.

R EPORT OFVITAL STATI STIC S OFTHE STATE OFM IC HIGANFO R THE YEAR 1 8 7 2 , by H. B. Baker,M . D. ,

Supt. of V i tal S iati st ics, Lansing, M i ch .

HAND-BOOK OFOPHTHALMOLOGY, by Prof. C .

Schweigger,University of Berlin

—p p . 546 .

Philadelphia : J . B. Li ppincoi t C O .,1 8 7 8 .

Toronto Willing Will iamson .

A COUR S E OFELEMENTARY PRACTICAL PHYS IOLOGY by M . Foster, M .D .

, Cambridge,assisted by J . N . Langley, B .A. Third Edition ,pp . 260. London McM i llan C O . TorontoWill ing 8: Will iamson.

LEC TU RES ON CLIN ICAL MEDIC INE, by Dr. Mccal lAnderson

,Prof. Of Clin ical Medicine , Univers ity

of Glasgow. London : McM illan Co. Toronto :Willing Wi ll iamson .

Dr. Griffinmoved, Dr. Sinclair seconded,That in th e opinion of this Association “Contract

Practice,

” except in so far as i t relates to Government si tuations and Charitable Institutions

,is not

expedient in the interests either ofthe professionor the publ ic.I t i s therefore further resolved that the members

ofth is Association will not hereafter engage in suchpractice exceptfor such time as may be necessaryto terminate any exis ting engagements — Carried.

Dr. Dee moved , Dr. Healy seconded , that th isre solution be published in the “CANADA LANC ET”and C anadian y our nal of[ Med ical S a ’

ezzce.”

Carried.

The society then adjourned to meet at Brantfordon the first Tuesday in September.

A COU RS E OFPRAC TIC AL INSTRUCTION IN ELEMENTARY B IOLOGY, by T. H . Huxley, LL.Dassisted by H . N . Martin , B .A.

,M.E. , Prof. of

B iology in Johns Hopkins’Universi ty, Bal timore ;th ird edition

,revised

,pp. 270. London and

New York McM illan (Sr C O . Toronto Wil lingWill iamson .

This i s an admirable l ittle work on the subj ect

ofElementary Biology and will be found of greatvalue to the student .

The author ofth is work has been long andfavorably known in the ranks ofmedical l iterature,as an abl e writer and successful teacher. The book

contain s 1 8 l ectures,and the various topics are dis

cussed with freshness and original ity, and also in

0

a pleas ing and interesting manner. I t wil l repay a

careful perusal .

THE CANADA LANCET.

TEXT BOOK OFPHYS IOLOGY, by M .Foster

,for the

'

care ofinfants . I t bears internal evidence

M .A., M .D . ,Cambridge ; with il lustra ofhav ing been written by a medical man , and

tion s ; second ed i tion , revised and enlarged ; many ifnot all the statements contained in i t, will be1 8 78. London : McMi llan & C O .

Toronto : fully endorsed by the medical profession in Canada.

Will ing W i l l iamson .

I t i s cleverly wr i tten and cannot fail to interest,

This work was favorably received from the first,amuse and ins t i The busy bOd ieS and old

nurses “ whose only recommendation is that theysoon after the

and th e present ed i t i on , l S SLl C d 50. f

have ra i sed a large fam i ly of ch i ldren themselves ,first

,15 ev i dence Ofi n creased and 100 3 3 5 108 avor. come

‘

i nfor a fair share Ofattention . The author’s

I t is fully abreas t Of the most recent advances i n Idea 15 , to educate women for nurses , pay them .

th is important subject. A large section ofthe l iving “7 3 86 5 , and hold them responsible. Every

work is devoted to the d iscussion ofthe con tractile mother should read this bOOk, and every father too , ‘as on the thread ofth e s tory 15 strung a large'

0 st ionU S S U C S ah d the vascular m echan i sm D i

ce amount ofu seful and pract i cal Informat i on , not;

and resp i rat i on are also treated ofIi i a most ex only what to do bu t how to do it.

haustive manner. O ther subj ects, such as blood ,Secretions, nervous and glandular systems, are

notAMER I C AN ED ITION OFFAR QU HAR S ON’

S GUIDE .

To THERAPEUTIC S . New York : H . C . Lea. .

td i scussed asi‘

x ully as the abovement i oned, bu Toron to : W i l l i ng Will iamson .

they are al l treated ofIn a thoroughly or ig i nal and We have much pleasure in introducing to th epracti cal manner? The book i s one Wt h we can profession

.

a very useful and compendiou s l i ttl e .

fully recommend as a work ofreference for the work ent i tled a “ Guide to Therapeutics and .

Materi a Med ea ,‘

by Dr. R obert Farquharson ,l ecturer O i . Materia Med i ca at St. Mary’s Hospital

THE SOURC E OFMUS CULAR POWER . By Aust in The volume , al though smal l in bulk— which by.Fl int , Jr. M . D.,Prof. of Physiology in the Bel l the way we cons ider a great recommendation .

vue Hosp ital Med ical Col lege. New York zD .both to the busy practition er and student

Appleton & C O . Toronto : Hart R awl inson .treats on the general actions

,therapeu ticaL

The author in th is l ittle brochure 0" about 100 and.

phys i ological Of medicinal agents . BY a con ‘

ven i en t arrangement, the corresponding effects in.0 nd conclus i an s drawn 0

pages octavo, g i ves arg uments a heal th and d i sease of: each d rug are represented i n

from h i s own observat i ons, and those of others, upon parallel columns, thus rendering reference easier”the human subj ect under cond it ions of rest and of and impressing facts strongly on th e m inds ofth e

In the i ntroductory chapter hereader. The first chapters d evoted to rulesfor:

muscular exercise.

combats the statement of D r. Pavy in the LANC ET prescr ib i ng comb i nati on Ofdrugs

,form Ofadm i n

Is trat i on ,proper t ime for exhibition

,dosagehfor NOV 187 6 3 Thatfood may be 1“)d intervals between doses, individual pecul iari ties,

upon ,not S imply as so much ponderable matter, but i d i osyncrasy, constitutional or toxic effect from

as matter hold ing locked-upforce, and thatby thcplay smal l. doses, chemical and physiological incoma

of changes occurring in the body theforce becomes Pat lb lhtles ; prescri b i ng for C hild?en , prescriptionwri tin wei hts n

liberated , and Is man i fested as muscular act i on , n er

g,

g a d measures,Observat ions U PO“

doses,general rules for doses. As before remarked

vous act ion , ass im ilat ion ,secre tory or nutritive ac the balancing ofth e therapeutic action with the

tion

,etc.

” He then treats of the nutr iti on and physiological is arranged by corresponding columns

development ofmuscular t issue, and its relat ion to in d iagrammatic form , having regard to exte rnal

the el im in at ion of n i trogen . He g ives the experiact i on , Influence on the bra i n and spinal andsympatheti c system Ofnerves on th e heart and

m ents of Li ebi g, Lehman , Em and VIsl i cenus , and blood vessels, on resp i rat i on an (1 temperature,on .

Parkes ; al so the experiments of Dr. Pavy and h im alterations of secretion in the order,urinary

, in

sel f on W

eston the pedestri an , duri ng h i sfeats oftestinal, sal iva ry and cutaneous. The various

walk ing,and concludes that food i s not d irectly modes Of el im ination from bOdY; antidotes, C OH

converted into force in the l iving body, nor is i t a tra

-i nd i cat ion , best modes Of prescribing, and ii l lustra ted prescriptions . Dr. Farquharson sa 5 on

source of muscular POW“ ,except that I t mai nta i ns the subj ect Ofbalanc ing the physiological against:

S tudent and practitioner.

the muscular system i n a proper cond i t ionf01‘ i t the therapeu tic action ofa d rug,that i t cannot

always be accurately done either from want OfHow WE R AI S ED OU R BABY : BY a Bened i ct. sufifiC i ent knowledge or from an excess offactsThis i s a most interesting and instructive book . more or less ofa confl icting natu re. “ We must

In the form ofa novel It g ives In a most attract ive remember that our therapeutical evidence is derivedstyle ,

important and valuable rules and suggest i ons from cl i n i ca l Observation on man , and that exper i~

3 52

ments on th e lower animal s has suppl ied u s withmost ofour knowledge respecting the action

.

ofmedical agents on the heal thy organism .FallaC Iesmay readily creep into both these methods

.

of

i nvestigation , and i t is eviden t how th e cl in i calmethod may be hampered by our

_

wan t offul lknowledge of the natural history ofd i sease.

” Dr.Farquharson shows the obj ects inv i ew in prescri b

ing,in the combination ofmed i c i nes, and po ints

o u t the faul ts which frequently occur. The workcontains a large collection of prescriptions ap

propriatelyarranged accord ing to effect. We have

derived much pleasure from a perusal ofth i s work ,and would strongly recommend it to practi tionersand students .

WYETH’S D IALYS ED IRON, BY LUNS FORD P. YAN

DELL, M .D . Professor ofTherapeuti cs and

Clin ical Medicine in the Un i vers i ty ofLon i svflle.

A year since,when Dialysed I ron was a

n ovelty, I commended it in the News , as a most

valuable addition to th e Materi Med ica. Twelvemonth s ofadditional experience have confirmedmyfaith in its excellence. The Obj ect ofthis note

is to call attention to the great var i ety ofspur iouspreparat ions sold under the name of D ialysed Iron .

Some ofth ese were manufactured here, but mostofthem were made elsewhere. Genuine DialysedIron is nearly tasteless. I t has the faintest poss iblesal ine flavor and a mere suspicion ofroughness .:Slightly d ilu ted , i ts taste recalls that of fresh blood .

I t i s no t in the least unpleasant, and does notblacken the teeth or tongue. I t seldom or neverproduces any gastric disturbance or headache, andvery rarely constipation. I t IS exceedi ngly rel iableand rapid as a ton i c.The spur ious forms ofth i s drug are W i thou t the

characteristics oftaste and effi cacy above eu

umerated ,and chemical analys is readily detects

their deficiencies. One ofthe Spur ious Spec imensbefore alluded to , was l ittle less unpleasan t than

the Tincture ofMuriate of Iron , another was exc essively ac id

,another was

.

decidedly Saline,another was exceed ingly astri ngent, another wassweetish , another was bitter, and ano ther was

s eemingly only colored water ; anothe r more nearly

approached correctness,but only a S i ngle speC Imen

possessed the pecul iar i ti es of the true art i cle.My attent ion was firs t d i rected to th i s matter

through thefai lure or bm i sbehavror ofthe D i a

lysed Iron in practice. I t i s but just to say thatthe good specimen is from Wyeth Brother,the original manufacturers ofth i s med i c i ne i n

America. e th ’s Dialysed Iron sells at about a

dollar a pound. O ther makers may be bought atfifty cents.”

TRAUMATIC HERN IA or THE LU G NG LIGATUREAND EXC IS ION ,

‘ R EC OVERY.—A man , aged 24, re

ceived a stab wound in the n i nth i ntercostal Space

THE C ANADA LANCET.

NEw R EMEDY.— It seems as though Australia is

to give us another valuable medicine besides thatderived from the Eucalyptus tree. c

flfshe leaves ofthe so -called cork wood (D ubcz

'

sz'

a my oporoz'

zies)yield a powerful extract sim ilar in i ts action to atrop ine and belladonna

,but more Speedy and en

ergetic. In New South Wales and Qu eensland,

where these properties have recently been developedby experimentation upon an imals , the new drug isalready considerably used in place of atropine.

fi i i‘ttm, summer, grains.

At Harris ton,on the 6th ofJ une, the wife of S .

M . Henry, M .D .,ofa son.

In Toronto, on the ofJune

,the wife of E.

( left ) , penetrating the pleural cavity, with slowand J . Barrick, M .D .

,ofa son.

small pulse. No vesicular respiration at the base ofSpiration and cough ing did not affect its volume norform . Ligature appl ied and tumor cu t Off. Thewound healed in 28 days. Seven months later therewas no trace ofth e lesion beyound the cicatrix inthe skin . M . C auvy,

who reported the case,con

siders th is accident afortun te complication ofpenetrating wounds of the thorax. I t prevents bleeding,and the entrance ofair

,and transforms a penetrat

ing into a non -penetrating wound . Fatal con

sequences have followed the reduction ofthe lung.

Ligature and excision effect a more prompt curethan an expectant method of treatment.— G az .

H ead,1 8 78, No . 8.

—N. Y. M ea’

. y oum al .

BLAC K L I ST. Black list ’Lis fl

proposed to beprepared by the physician s ofToronto Hamiltonto protect them from that class ofpersons who ,though able to pay, go about from one to another

,

getting the services ofeach as long as possiblewithout paying. I t is proposed to report the namesofsuch p eople , by printed lists and a C opy will besupplied to each physician

,for mutual protection .

R EMEDYFOR S EA-S i cKNEss .— A new remedy is

said to have been discoveredfor sea-s ickness, viz .

apomorphia,a very small dose ofwhich taken once

an hour in water will remove the qualms. I t isalso sa id to be usefulfor beasts

,the suffering of

which are Often extreme.

SPEC IAL EXAM INATION , COLLEGE OFPPYS IC IANSAND S U R EG ONS

,ONTAR IO .

— The following gentlemen passed before the Special exam iners appointedby the counci l a t i ts late meeting, v iz . Drs. C omford

,R yerson

,Nev itt Bomberry.

APPO INTMENTS .— Dr. F. G. Slack, M .D . , has

been appointed Prof. ofSurgery, and Dr. Armstrong .

Lecturer on Anatomy,in B ishops College medical

School, Montreal .

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THE C ANADA LANCET.

As the rem issions of thefever, in th is case weremore dis t inct, I gave h im qu in ine in large doseswh i le thefever was off

,so that he generally took

about ten grains during the rem issions, wh ich las tedaboutfour hours otherwise the treatment cons istedof aalyci lic acid in a solut ion of l iq. ammon . aes tatis.al ternatel y w i th sulph i te of magnes ia, everyfourhours. For a week , or so, after the appearance ofthe petech ie there was very l i t tle change in the

symptoms, and then the rem iss ion s became longerand thefever left ent irel y about the 6th of Septemher

,about five weeksfrom the incept ion Ofthe

d isease.

C ase 3 . Mrs . K.,set 36, was attacked on the 4th

ofAugust w i th nausea, headache, pain in the backand l imbs

,etc.

,bu t thought that i t was only a ch ill

and would wear Offhowever as she cont inued to

get wors e I was sentfor on the 13 th , and found herin a h ighfever, pulse 95 , temperature 101, tonguedry brown and crusted , great pain in the stomach

and bowels,there was also severe pa in in the head

above the eyes,“and great prostrat ion . S he had

taken two or three doses Ofpi l ls, but they had not

operated, and the bowel s had n ot been movedforfive or six days.

gativ e ofpulv . j alap hydrg-cum creta and podo

phyll in,

.whi ch acted freely, although vom i t ingtook place in an hour or so after tak ing the powder,and a great deal of brown scybalous mattter came

away . In th is case the stomach was very i rri tableand there was a good deal ofpain in the bowel s, although there was Very l itt le tympan i t is. I ordered

s inap isms to the pi t of the stomach , and bowels , an dprescribed b ismuth everyfour hours, w ith sal icyl icaci d and l iqu id amm . acetati s between t imes . Therewas l i ttle or no change in the symptoms until the30th when she had a severe chok ing paroxysm , and

vom i ted a worm about n in e i nches long, wh ich wasfol lowed by a great deal ofi rri tat ion ofthe th roatand pain in the stomach next day she had a severe

attack of diarrhoea, the mot ions being veryfrequentand bloody at th is t ime there was also wanderingdel irium and great prostration . The di arrhoea was

soon checked w i th pulv. Op i i . and plumbi acetati sabout th is time al so a smal l m i l iary erupt ion appearedand conti nued for nearly a week , after wh ich the

pat ient began s lowly to recover, and the convales

cence was very tedious, w i th sl ight relapses, wh ichseemed to be caused by certa in changes of d iet,such as eatin g a l i ttle boiled cabbage, or part of an

I immediately adm in istered a pur lfevers that can be rel ied on .

apple,&c. However she eventually made a good t e

covary,al though n ot entirely wel l un til the 20th

of October,n ine weeks after the commencein ent of

the d isease. S ince then she informed me that shehad n o recollect ion of anyth ing that passed duringtwo or three weeks Ofthe fever

,and that her hair

has nearly al l fal len out. Th is case was the mostsevere of the three

,ch ieflybecause the ”patient was

worn out w i th bodi lyfat igue,and Very weak before

the d isease came on . After th is very brief synops iswh ich I have made

,as our t ime i s short

,and there

are other cases to come before our Associat ion,I

now proceed to consider the nature,cause

,and treat

ment of these cases . Strictly speak ing they m ightbe cal led typhoidfever

,as most ofthe symptoms

were such as are usually present in that d isease, al

though not in i ts severestform. Suchfeve s oftenassume various forms

,and are called bydifferent

names,wh ich after all have nearly the same mean

ing,such as enteric fever

,gastric fever

,gastro-en

terio,typhus and continued fever. Some wri ters

prefer one name and some another,but I am in

clin ed to agree wi th Watson , when he says,“ There

i s no l ine of genu ine d ist inction between cont inuedThey run i nsens ibly

into each other,even the most d iss imi lar of them

and are often traceable to the same contagion .

You,no doubt

,have frequently met w i th cases

wh ich began as i nterm i t tent,or b i l iousfever and ul

timately term inated in typhoid fever,so that. the

one i nsens ibly ran i nto the other,and therefore

,

I th ink,cont inuedfever i s the most appropr iate

termfor such disease. As to the cause of such

fevers, and more part icularly of the precedingcases. The house's i n which the fir st two casesoccurred were si tuated near the r iver

,close by

the flats where there was a great deal of rot ten

Wild grass,wh i ch prev iously had been covered

wi th water,and as the water subs ided there natur

ally arose an exhalat ion of decay ing vegetable matter

,caused by the heat and moisture, wh ich accord

ing to the doctr ine ofcontagium v ivum vi ews, nowgenerally accepted by the profession, had no doubt

much to do wi th producing the di sease in thesecases. Most wri ters onfever, agree in attributing the exci ting cause offevers to nox ious exhala

tions ar is ingfrom certain soils , and that a combinat ion ofheat and moisture i s also necessaryfor theirproduct ion.

Lancisi gives the h istory of an epidem ic fever,

THE CANADA LANCET.

wh ichfor several summers infested and almost de

populated a town s i tuated in an elevated and salu

bri ous part of Etruria. Th is fever arosefrom the

emanationsfrom ponds of stagnant waters, in wh ichhemp and flax were macerated : On th is processbeing afterwards proh ib i ted there was no recur renceoffeve r. Dr. Bancroft states he was informed at

Naples that in several places near the city, and particularly in some beyond the Grotto ofPoslippo,sleepin g in houses contiguous to di tches in wh ichhemp or flax were macerati ng had been almost

constantly followed by fever. S imilar effects havebeen observed from the fermen tat ion whi ch the

indigo plant undergoes in the process of extractingthe colouring matter. I t appears that after the ex

traction of the dye, large heaps ofthe plant are

formed near the manufactories and houses of the

workmen for the purpose of undergoing decomposi

t ion so as toform manure. After beingfrequentlymois tened by the heavy rains

,and heated by the

rays ofa scorch ing sun , cop ious exhalat ion s takeplacefrom the beds of putrify ing vegetable matterin consequence ofwh ich the workmen

,and persons

who l ive near were constantly attacked with dangerousfevers. This circumstance havi ng of late years att racted the not ice of the planters, the plant afterthe extract ion of the dye , i s not permi tted to beformed in heaps near the works, or dwell ings of thelabourers. Fevers consequently are new compara

tively rareamong the workm en . Therefore in thetwo

first cases I th ink the ch ief cause was the miasmata

the patien t was previousl y in a weak

thfor some t ime, and there was a cer

ofdampness and want of proper venhe apartment i n wh ich she was con

oyed durin g the day, and also on ac

wi th the fever wh ich ensued. The treatment I pur

sued in al l these cases was chi efly expectant and cons isted in keep ing up the strength by proper nouri shment, watch in g the compl icat ion s wh ich usuall y ao

company or follow such diseases . I generally gaveb ismuth when the stomach was ir ritable. Bromideof potass or sulph i te of magnesia alternatel y wi thsalycil ic acid in a solut ion of l iq. ammon ia acetatis

,

and when diarrhoea supervened,I gave pul v. orpII

and plumbi aestat is. When thefever began to abateI stopped the brom ide of potass

,or sulph ite of mag

nes ia and gave ni tromuriatic acidand quin . with nutrit ious diet and a l ittle wine or brandy accordin g to

the taste ofthe pati ent. There is no doubt that thestate of the bowel s requires to be careful ly watched inthese cases

,and as those I have recorded were al l

troubled w ith const ipation at the fi rst,and during a

great part of the di sease,I began the treatment by

admin istering a purgative consisting of j alap andrhubarb wi th a l i t tle hydrg. sub. mur. or hydrarg. c.creta. Afterwards during the course ofthefever I general l y gave castor oi l with afew drops oflaudanum

,whi ch Ifound to act very sat isfactori ly.

There i s cons iderable d ifference of opin ion,among

medical men,wi th regard to the use ofpurgat ives

m typhoidfever,some advocat ing thefree use of

purgati ves,and others the adminis tering of estring

ents . Most of you , no doubt, have read the in teres t

ing paper On the management of the Bowels i nEnteric Fever by Dr. Gri sham of Dubl in

,wh ich

has been cop ied into several of our Canadian med icalj ournals, and I cannot refrain from quoting the

closing paragraph , in which he says I bel ieve themain point to be attended to in the management of

the bowels in entericfever is to keep them free,bu t

not too free,and to avoid as much as poss ible pur

gat ives or as tri ngents .

There i s on e poin t wh ich has created a good dealof di scuss ion , and wh ich I shall refer to very briefly,that is the question of contag ion . Dr. Budd holds

that i t i s strictly contag ious , and gives this as one

of the proofs of i ts being a specific fever. Dr. Mur

ch ison bel ieves that i t is not contagious in the strictsense of the term

,and that i t is never propagated

by a thi rd person . Some again adduce the appear

ance of an erupt ion as an ev idence of i ts contagion,but we all know that petechi ae do not appear i n

every case. In the cases mentioned here there wasonly one in wh ich the spots were dis t inct, andal though an erupt ion showed i tsel f in the thi rd case

35 6

about the crisis of the fever, sti l l such an erupt ionm ight be caused by the opium that was given to

check the d iarrahoea. I do n ot th ink that you w i l lfind petechiae in more than one-hal f

,or two-th irds

at thefarthest, in al l the cases oftyphoid fever thatoccur in th is country. Therefore the opin ion Ihave formed,from my own experience is

,that ty .

phoid fever to a certain extent i s contagious, yetthe contagion is n ot of that v irulent type wh ich i sobserved in many specificfevers. Yet i t i s certainlyadv isable to treat i t as if it were strictly contagious,by payi ng great attention to cleanl iness and vent i lat ion

,as wel l as the free use of d isin fectants.

CASE OF TALIPES IN A BOY OF 1 6 YEAR SOF AGE, WITH SUCCESSFUL OPER ATION AND TR EATMENT BY PLASTERCASTS .

BY DR . BURROWS OFLINDSAY.John King

,having Talipes Varus of left foot

wi th all i ts wel l marked characteris tics , appl ied tome some months agofor th e rel ief of his deformity.

He had only been able sadly to hobble about by

the use of a cru tch and cane, the foot was greatly

misshaped,malleol i enlarged

,with skin and flesh

covering much thickened and callosed , from

walking on that part ofthe foot. By advice ofmedical men ofmore or less celebriety, a numberofwhom he had previously consulted, almos t everyconceivable appl iance and apparatus had been

used but without any appreciable good resul t.The boy, anxious for prospective rel ief was

easily pursuaded to an operation , which I per

formed ou the 23rd ofMay last, assis ted by Dr.T. W. Poole

,who kindly admin istered the anaes

thetic, us ing a fine Tenotomy kn ife, the contractedtendons were divided

,also the plantar fascia and

muscles which were carefully d ivided,cautiously

avoiding the nerves and arteries in the neighbor

hood, the operation progressed wi thou t serious

hemorrhage or any troublesome complication,and

havi ng been satisfactori ly completed the l imb wasfairly straightened and set in an improvised spl intofleather, and perfect rest insisted upon .

On visi ting him the following day, found that hehad rested n icely, very l ittle soreness or pain beingcomplained of

, the foot keeping its position . I

now reappl ied strips of adhesive plaster with tension

THE CANADA LANCET.

offoot inwards , and to the ou tside appl ied amoulded spl in t ofstout leather, allowing all to remain in situ afew days . I now procured a stou t

pasteboard box and having satisfied myself as tothe position ofthe foot and exerting increased

traction by the adhesive strips, I placed againstthe s i le ofth e foot a moulded splint well waddedwith cotton wool with a view to prevent undue

pressure from the contract ion ofth e plaster insett ing

,and to secure greater comfort to th e l imb

in its lengthy incarceration. The foot be ing placedon i ts inner side with box , the plaster ofParisin water

,to which a smal l quantity of common

salt had been added to accelerate its setting,and make it more firm, giving a complete

casing of about an inch th ickness , and whichtrimmed a l ittl e, left a close fi tting comely coveringofsol id plas ter

,securely fixing the foot and

thoroughly insuring its remain ing in the desired

position. On my following visi t I found him tohave sl ept well

,eaten well

,and the foot feel ing quite

comfortable. Everything appearing so favorably,I left the foot again in the same positionfor someeight or ten days, at the end ofthis time , a pertionofthe plaster cast being removed from the outer

Side to below the ankle joint, I pressed the foot

stil l further outwards,even beyond its natural

posit ion,and having poured fresh plaster around i t

secured it in its new position,and left my patient

again fairly comfortable . In th is posit ion I left my

patien t until the z end of June, when I entirely re

moved the plaster casing,find ing the l imb perfectly

straigh t and of natural shape, almost as i ts fel low,th e previously enlarged malleol i and callosi ties lessnoticably prominent. I had h im now put on a

laced boot specially stiffened on th e inner side witha double thickness ofstove pipe iron , moulded tothe last on whic h the boot was made, and concealedbetween the side leathers . He at once endeavoured

to walk and could do so, rest ing part of his weighton the previously affected foot. He complainedhowever

,ofa stiffness in the j oint, and a feel ing of

weakness,but with a walking

make fair locomotion . He has ,writing

,d onated that last rel ic of

is able to walk nearly as well as anybody ;has assumed an almost natural shape andand the j oint is gradually becoming ofnoand greatly strengthening.

I have though t this worthy ofinsertion .

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THE CANADA LANCET.

the following reasons this designation is still

obj ectionable —r st,because often up to almost the

close ofl ife, the patien t is not paralytic— 2nd , his

so called Paralysis is not general , unless by th is

term we understand indefinite,not special , not

topical,not constant, or unvarying. Some walk

about briskly,work well and will ingly

,up to afew

hours before their final exit,which occasionally is

precipitated by an apoplectiform seiz ure,with

cep ious sanguineous, or perhap s only serous,effusion on the surface or in to the ventricles of thebrain.

In Germany and America the term Paresz'

s has

now been preferential ly substituted. Some wri tersstil l retain the adjunct general,

” but I can see nogood reason for this qualification— the word Par es is— implying as it does

,not an absolute

, or total,

deprivation of motor power,nor even a great

diminution of it, but a gradual weakening and

impairment,seems to me to come as near to the

requirement as we could wish . I have,therefore

,

for many years,used this designation and if i t had

no other recommendation than that ofarbitraryremoval ofth e disease from general medical

nosology,in to the domain of al ienism, I think i t is

entitled to the approval of the entire medical p rofession .

I have said that the disease is not one of

obscure diagnosis,even in its earl iest stages

,

” but

perhaps I have here spoken rashly for who cansay w izen insanity of any form

,aeg i fl s ? Do we not

every day meet with men and women, who, though

not palpably insane,and duly qualified for asylum

lodgment, are, nevertheless very over , or under

active members ofsociety,or very perplexing

members oftheir domestic circles ? A large

majority ofthese may float on through l ife without the stigma of lunacy having disfigured their

fair repute,yet I have l ived long enough to realiz e

,

inside the twalls of an insane asylum,adequate ex

planation ofmany a moral paradox which I hadwitnessed long before

,outside.

And j ust so is it with,as I believe

,th e maj ority

ofal l paretics— not, firs t, i s i t, when a man breaksout into a sudden outburst of insane passion

,or

violence, or exhibits some gross moral impropriety,which astounds his relatives and friends

,that

.

h ismind has begun to be unsound— enquiry will hardlyever fail to elici t from those who have long and

intimately known h im,that for many months, or

years,before the formidabl e outbreak

,— ifnot in

deedfor all his past l ife, —they had noted in his

demeanour, or conversation , unaccountable pecaliarities, but until now, they had never suspected

the presence of mental unsoundness.Who would venture to say how large, or how

small , may be the proportion ofall bold proj ectorsand daring speculators

,— successful or unsuccessful

—who have been exempt from morbid cerebral

taint ? Neither the abundance, nor the fineness,ofour treasure, renders infrangible the earthen

vessel s in which we hol d it; too often , indeed, the

very opposite is th e fact. But nothing in this

world is so successful,as su ccess and no wisdom

is in the eyes of the mul ti tude so wise as that which

has enthroned itself on the gold-sack.

I t may not be the invariable fact, but it will be

found offrequent obtainance , that pareti cs havebeen men ofunusual mental force and grasp. Some

of them may have made achievements that have

astonished th e ir quiet,cautious

,neighbours ; but

this,

astonishment has finally been ecl ipsed by one

far stranger, a nd far sadder. I feel sure that thereis not one who now hears me, (but more especiallynot one ofmat urer years), who has not witnessedmental dethronements ofthe sad character hereal luded to .

Paresis has e ither immensely increased during

the last half century,or before th is period it must

have been very defectively noted— both facts may

be terrible . Before the time ofPritchard , i t wasvirtually unknown

,or it was unwit tingly ignored,

in England. To day its existence there and

though to a less extent,in Scotland and Ireland,

i s fearful.When I entered the Toronto Asylum in 1853,

there was not a single cas e,as far as I could j udge,

In the insti tution , but it was not long before i t

began to make appearance. I have not at present

at my command,the figures showing the mortal i ty

during my whole p eriod ofservice but I can statethat in my last 1 0% years from r st Jan . 1 865 to

roth July 1 87 5 , the deaths from Paresis amounted

to 7 2 , of those 65 were ofmen , and only 7 ofwomen . I believe th is is very near the proportion

as to sex,which obtains' in those asylums of the

United States with one exception in which Paresis i smost largely found

,or is most accurately diagnosed .

In the 2% years from 1 9th July, 1 87 5 , to r st Jan .

1 878, the deaths from Paresis in the Toronto

THE CANADA LANCET.

Asylum have been 23 , including that ofonly one

I t is a melancholy confession,but i t is the truth

,

that the asylum death records ofParesis, have beena pretty nearly correct statement ofth e number ofcases of this d isease admitted— a -few,

indeed, of

these patien ts were taken out by their friends , be

fore death ; bu t not a s ingle one escaped the

destroyer— I bel ieve the total death sfrom Paresisin my time

,was about 1 20.

The two lates t Engl ish reports wh ich I have re

ceived, (from Sheffi eld and Exeter,) show the

following figures for death s ofParetics, in 1 8 7 7 .

Sheffield— 28 men,

‘

6 women,total

, 34, in a

total of1 05 deaths , or nearly one-third. Devon,

(Exeter), 1 0 men,2 women

,total 1 2

,in a total of

50 deaths , nearly

The total numbers res ident in the year in theSheffi eld Asylum were 36 1 men and 463 women ,therefore the actual paretic death proport ion ofthe sexes was not as 2 5 6

,but as 28 to 4 1

76 , or

about 6 to 1 .

In th e Devon Asylum,th e total resident were

285 men, and 46 2 women , therefore th e actual

paretic death proportion was not as 10 : 2, but

nearly as I O to or 8 to 1 .

The figures ofth e Sheffield Asylum representingas they do, the incidence ofParesis in a largemanufacturing town , may be taken as an approximate representation ofthe frequency ofthedisease in other large English towns ; whilst those

of the Devon Asylum are perhaps,fair exponents

ofi ts prevalence in mixed town and country

populations .

In Sco tland, with the exception ofth e city ofGlasgow, the proport ion ofParetics is not muchgreater than i t is in this coun try ; and in Ireland i tis apparen tly less .

( To oe C ontinued .)

TR ANSLATIONS FR OM FOR EIGN JOURNALS .

Editorial.

of Le P rogr ess Med ical,8 th ofJune.

DR . BOURNEV ILLE,PAR I S .

There are yet to be found men who in spite of

the march of ideas, cannot accustom themselves to

the thought , that the elected representatives of the

359

p opulation of a great city should have the power

to bring about reform. Elected in a manner,more

or l ess s ingular, and after a system which falls into

desuetude, because it res ts on oligarchy, these

worthy people who have no influence on publ ic

Opinion , take it in to their heads that they have an

apti tude for deal ing with questions beyond their

ability, and wh ich they have only examined cursorily by the sol e l igh t oftheir prejudices, ac

complices oftheir ignorant self—sufficiency. H ow

ever hard , however severe may appear at first sigh t

th is j udgmen t, i t wil l be perceived by the following

quotations that i t is fully warran ted . In the second

page ofthis report, M. Pran de Sain t Gilles,Notary,

gi ves involuntary reason to these Municipal

Councillors, suffi ciently revolutionary, to demand apartial appl ication ofth e lay elemen t in nursing.The following are h is own words T/zal special

lzosp i lals,founded and sustai ned byfr ee association s ,bold to Me preser ving lbe C al/colic, P rotestant, or

j ew i s/z c/zaracter oftheirfoundation , not/t ing can be

morej ust, t/ze public nur s ing i s and oug/zt to remain

la_y, open toall w i l izout distinction ofcreed , i ts miss ionis to cure

,and not to conver t.

”

Such premises would naturally ‘ l ead a logicalmind to recogniz e that the desire expressed by theMunicipal Council , a very natural desire, since it

l im ited itsel f to requesting the Board ofGuardiansto place lay trained nurs es and novitiates in a newhospital , and ought to have been taken into con

sideration. Well , th e author ofthe precedingextract has arrived at a conclus ion in a radicallyOpposite sense. This seems al l the more strange

that he confesses that certain critici sms pointing tonuns, are, alas but too true.

I t is obj ected that nuns are on certain daysabsorbed by exercises ofrel igion at the expense ofth e ir hospital duties, ofneglecting the wards ofthe patients, for the chapel ofth eir community.I t is true that their rules exact the accomplishmentofreligious duties, which necessi tate at t imes theirabsence from the wards . I t is tru e also

,that some

medical officers have been able to establ ish these

absences, and to regret them under circumstances

when i t would have been preferable that theyshould have sacrificed rel igious duties to th eexigencies ofan acute disease

, or to an urgen tdressing.”

Precious acknowledgments,that th e journal s

wh ich have undertaken the defence ofthe nuns

THE CANADA LANCET.

have taken care not to record. The division of the Hospital of Lyons,to procure for them Sisters .

t ime ofthe sisters ofcharity in one ofthe hospital sofParis, and in one of the insane asylums oftheSeine

,published in the Progress Medical

,and wh ich

nobody can deny, shows how great i s the time

al lotted to religiou s exercises prescribed by the

rules ofth e community. The reasons invoked by

M. Pean cle Saint Gilles, to prevent the Board from

acceed ing to the prayer ofth e Munic ipal Council,deserve to be made known , not because they are

of an incontestable accuracy but because they are

al together original .“ I t is certain that you never see sisters of

charity betray their vows ofchasti ty,of renouncing

the world and of self sacrifice. Wi th them you

have no occasion to fear the dangers ofhumanfrail ty

,which it is unnecessary to particulariz e.”

M . Pean de Saint Gilles,in h is position of

member ofthe Council ofSuperin tendence,should

have in formed himself from the records oftheBoard, before committing himself so imprudently.

What would he have learned ? That a yeardoes not pass without some lost sheep escaping

from the fold . More,he would have learned

,that

occasionally unheard ofacts of scandal occur,that

last yearfor in stance , a sister was surprised sacr ificing with her friend to th e Lesbian Venus

,and d riven

from the hospital . What then can we th ink ofM . Pean de Saint Gilles

,if having carefully obta ined

information , he has nevertheless persisted in

writing the passages we have extracted. M . de

St. Gi l les, moreover, endeavors to prove that theS isters have been calumniated in

_

attribu ting to

them an excessive ardor for proselytis ing. Per

verse are those who doubt that the Sisters

beset and worry the patients,to attract or draw

them back to forms and practises that they bel ieve

necessary to their salvat ion . How many facts

could we cite here , showing the procedures ofth eSisters in order to force the patients to mass

,

to th e confess ional , and to all that follows .There are but few of our readers who are not in

possession ofsimilar facts. M . P. de St . Gill es,for combatting the idea ofadmitting the lay

element into hospitals,rel ies upon a fact

,which

,

according to h im has recently happened in Switz eran d

A m ember of our commission remarks upon a

very characteristic fact,Berne

,a Protestant C i ty

,

has recently asked th e Board ofadm inistration of

of Charity, for the service ofi ts ch ief hospital .Unfortunately M . de St. Gilles

,does not give us

the name of his so well informed colleague . M .

de St. Gilles, has been deceived, we have enquired,and by a letter from a most distingu ished phys ician we learn , that nothing of the kind has ever

taken pl ace as deposed by the Secretary ofthehospital in quest ion

,moreover that none ofth e

hospitals in Berne neith er large nor small are

served by the Sisters. The Cathol ic population ofthe J ura

,has different hospitals served by the

Sisters,but in one of them after a confl ict between

the Board and the S isters,a pr oportion of the latter

were replaced by Protestants.”

CUR E OF A CASE OF PO ISONING FR OM36 G R S . OF STR YCHNINE

,AFTER FIVE

HO U R S DETENTION INTHE STOMACH .

Translatedfrom the “ P er/ i smM ed ica-Qn i r urg ica , BuenosAires , 8th May, 1878.

A young man , of1 9 years, ofexcellen t consti tution

,voluntarily swallowed two grammes (36

grains) ofcrystal ised strychnine, at midnight, aftera cop ious meal

,well aware, as he was a student in

chemistry, ofthe properties of the substance .Having previously secluded himself

,his condi

tion was undiscovered unt il five i n the morning,

when he was found in a violent accession oftetanicconvulsions.We saw him in fifteen minutes after

,in a brief

peri od of calm,which permitted h im to u tter the

word strychn ia , but was instantly succeeded by a

tonic attack,in which every muscle was engaged,

and imminen t asphyxia was threatened. Whilst

we caused to be prepared the solution mentioned

below, advantage was taken ofthe absence of th ecanine and first molar teeth

,for the introduction of

a pint of ol ive oil. The trismus was strong, and

no vomiting had yet taken place.In the second place an enema of 500 grammes

ofbrandy, with a like quantity of water, and twogrammes oflaudanum

,was administered

,to secure

retention ofwhich a tampon was inserted in th eanus

At half-past five o ’clock the following solution

was introduced into the stomachIodurat. Potass. .4 grammes.Iodin i pu lvi . I

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362 THE CANA'DA LANCET.

.

i t m ight be,and in doing so we will omit certain

extremely rare kinds ofabdominal tumor.F irst ofal l

,I have no doubt the idea ofpregnancy

occurs to you . I t is th irteen,

months since thepatient’s last ch ild was born , and so it i s altogetherpossibl e that another foetus may now be at ful l term .

Again,i t might be an ovarian cyst

,and, as Ihave said

,i t presents very much , indeed, the ap

pearance ofone.

Then,again

,i t might be a uterine fibroid .

Next,i t might be due to abdominal dropsy.

In the next place,i t might not be a tumor at all ,

but s imply an accumulation of fat in the abdominalwalls.Stil l further

,i t might be due to tym panites.

In examining whether the enlargement may notbe dependent on some on e of the several cond itions suggested, let us begin with the lasttympanites. The question of tympanites is at oncedefinitely settled by resorting to percussion overthe surface ofthe tumor. When th is is done, wefind that there is everywhere the most completedulness

,amounting to absolute flatness ; and we

can therefore safely conclude that we have to dealwith some body which is certainly not a

'

eriform incharacter.An immense mass offat has been mentioned as

a possible explanation ofthe tumor here present.I once performed ovariotomy in a case in whichthe diagnosis was somewhat obscure in certainrespects

,and when the incision was made in to the

abdomen I found a deposit offat at least fourinches in th ickness in its wal ls. But i f the re werea mass offat, i t would be superficial, so that bygrasping the abdominal walls deeply with thefinge s, we would get under it, which is found to

be impossible here. Then , again , great obesitywould scarcely be suspected from such a historyas has been given ofthis pat ien t.Now,

l et u s see wheth er the diagnosis of pregnan cy wi l l stand the test ofphysical exploration . Iexam ined the uterus thoroughly by conjoinedmanipulation

,and finding it ent irely undeveloped

,

apparently,ventured to introduce the probe

,when

I ascertained that i t passed easily to the fundus,

and that the canal of the organ was only ofnormallength . In addition , the woman has cont inued tomenstruate regularly every month .

Might i t not be a uterine tumor ? Probably not,

because we have been able to map out the s iz e andshape of the uterus, and are able to move the organfreely about by means ofth e uterine sound withoutproducing any effect upon the tumor. Then

,

uterine tumors are almost always solid in character,

and here we get a distinct sense of fluctuation .

Is i t ascites? Suppose you place some intestinesin a tub ofwater. They wil l at once r ise to thetop . So here

,if we had ascites

,and the woman

were lying on her back , the intestines would floaton top. But listen to the percussion-note on the

site of the tumor. There is perfect flatness everywhere

,while upon the left side

,on the contrary

,

there is well-marked tympanitic resonance .,

We

must,th erefore

,exclude ascites. I t is true that

local iz ed peritonitis wil l occasionally shu t up fluidin some particular part of the abdomen. surrounding it with a wal l oflymph . In such cases a differential diagnosis between th is condition andovarian cyst is often exceedingly difficul t

,and one

might almost be considered excusable for openingthe abdomen with a view to performing ovariotomybut still , such a mistake wil l seldom be made if allthe means at our d isposal for making the diagnosisofovarian disease are employed .

From the physical characteristics ofth is tumorwe can decide with considerable certainty that i tis a fluid cyst of some sort . We have ascertainedby means ofth e sound that i t is entirely distinctfrom the uterus. Is i t then an ovarian cyst ? Suchwas my impression when I first saw the tumor ;but

, on mak ing a careful examination , I found twopoints in connection with i t which mil itated verystrongly indeed against such an hypothesis. Thefirst was

,that I was u tterly unable to feel the tumor

with the finger in the vagina. The force ofgravi tation usually keeps the inferior part of theseovarian growths low down in the pelvis , where, ofcourse

,they originate. The second poin t was

that,on making percussion carefully up and down

the abdomen, on the s ide ofthe tumor, I was able

to make out a distinct area of resonance betweenthe latter and the position of the ovary.

.Then,besides

,i t i s a very rare th ing to find an ovarian

cyst localiz ed l ike th is. They are forced by themuscles wherever there is the most room for them ,

and so they are almost un iversally found in themiddle ofth e abdomen , though always commencingin the side.When I found that it was not an ovarian cyst , my

next thought was that i t was on e of those localiz edperitoneal dropsies ofwhich I have spoken . But Isoon found that i t was movable to a certain extent( though not very freely) , which would not havebeen the case with such a collection of fluid surrounded by walls ofinflammatory lymph and thenthere has been no hi s tory‘

whatever of any attackof peritonitis

,either general or circumscribed.

The next thing that wil l probably occur to youis that i t is a renal cyst. Several dases of tumor ofthis description have been cut down upon , underthe idea that they were ovarian , even by men ofth e most distinguished reputation . I t is certainlyposs ible that this may be the diagnosis here, thoughI think it is not probable.The question s ti l l comes up, therefore, what

then is i t ? There is stil l another kind of cyst ofwhich I have not yet spoken

,and that is the lzepal i c

cy st, th e growth being connected directly w ith thel iver itself. I t is so exceedingly rare, however,that i t i s scarcely mentioned i n medical l i terature

THE CANADA LA NCET.

at al l. A professional friend ofmine , who isadmirably qual ified to do so, has looked up thesubj ec t very carefully in the books and journals

,

and has been able to find almost noth ing in regardto i t. I do not

, ofcourse, now refer to the hy datidcys t of the liver

,which is well known , but am

speaking of the pure hepatic cys t. That i t is a condi t ion which we may be l iable to meet with occasionally, however, i s certain . Not long since ayoung surgeon in a neighboring place told me thathe was abou t to perform his first ovariotomy , anda short t im e afterwards I learned from him thatwhen he had opened the abdomen he found boththe ovaries perfectly heal thy

,but that there was an

enormous cyst ofth e liver, in which there was

nothing whatever l ike hydatids.

I th ink I am therefore j ustified in suspect ing thepresence of an hepatic cyst i n the present instance

,

and in order to derive what assistance we mayfrom an examination ofi ts contents, I have drawnoffa smal l quantity of the fluid by means ofthehypodermic syringe. You observe that i t is opaque,and ofa strongly marked yellowish color ; andProf. Dalton has pronounced i t to con taln the

coloring matter ofthe bile (not bile i tself, youunderstand

,but its coloring matter, at all events) .

You see the reaction with nitric acid upon th is plate.I do not th ink i t can be a hydatid cyst, as therehave been none ofthe features ofthis conditionpresent. I take it to be an hepatic cyst which isvery close to the gal l-bladder

,and whose contents

have,therefore

,become tinged with its coloring

matter. I t seems probable that a process ofexosmosis has taken place. I t could not be theenlarged gall-bladder itsel f

,for i t is impossible that

that should become so enormously distended. Oneother poin t corroborative ofthe supposition of thecyst’ s being connected wi th the l iver is the factthat. on percu ssion , there is no line of resonancewhatever between the l iver and the tumor

,there

being one continued area ofdulness from the upperborder of the l iver to the lowest poin t of the growth;while

,as you remember, there i s a l ine ofresonance

between the lat ter and the pelvis. In addition , Ifind that the left lobe ofth e l iver is very large andprominent

,so that it can be mapped out with great

distinctness,and the hand sl ipped under it, as is

usually the case when there is a large fatty l iver.I t would

,at all events

,indicate some diseased con

dition of the organ .

Having at length arrived at a probabl e diagnosis,we come now to the subj ect oftreatment. IS anything to be done for this patient, and , if so , what ?I t seems to me that some interference wil l have tobe practised in the case

,from the fact that the

cyst i s increasing in siz e so rapidly. But,at the

same time,any Operation l ike that for ovar ian tumor

is out of the question . I f this growth is an hepaticcyst

,i t i s not at all l ikely that i t can be removed

w i th safety to the patient. In ovarian cyst, draw

ing offthe fluid 15 no longer resorted to by any oneas a sanative procedure. P aracentesi s ovar i i is

only ofse rvice as an aid to diagn osis and as apall iative measure for the rel ief ofcertain urgentsymptoms. But here I think we migh t perhapsdraw offthe fluid with advantage. I s there nodanger in such an operation ? you ask . Yes, thereis great danger from the escape offluid into theperitoneal cavity

,for fatal peri tonitis migh t easi ly

resul t from this cause. You know that oflate yearsgastrotomy has been several times performed ; andyou have probably all heard ofthe celebrated caseofM . Labé, of Paris, in which a sil verfork wasextracted from the patient ’s stomach by th is means.Before drawing offthe contents ofth is cyst, Ishould advise that an inflammatory adhesion shouldbe effected between the parietal and visceral layersof the peritoneum

,in the same manner as was

done in these cases,in order to prevent the fluid

from escaping into the peritoneal cavity. Thismight be accomplished by means of a s lough ofth e abdominal walls caused by the application ofn itric acid ; or, in other words, a n itric acid i ssue.Through the centre ofth is the needl e of th easpirator could be passed , and it i s poss ible that asingle evacuation of its contents might result In thecure ofth e cyst. I f i t did not, the operat ion couldbe repeated whenever it should become necessary.O f course

,no in ternal remedies wil l have any

effect whatever upon the growth . For me th isis an exceedingly interest ing case, and I trust i thas proved so to you ah a — M ed ical R ecord .

ABSTR ACT OFSIX LECTUR ES

ON THEDIAGNOSIS AND SUR GICAL TR EATMENT

OF ABDOMINAL TUMOUR S.

Delivered at i lze R oyal C ollege ofS urgeons ,I N T. S PENC ER WELLS ,

Hunterian Professor of Surgery and Pathology.The firs t lecture was del ivered on Monday, June

roth,at 4 p m . The lecturer entered at consider

able length in to the mode of exam ining patientswi th abdominal tumours , describing in detail themethods of external, internal, and combined examination

,and Showed h is form of noteb ook for

record ing cases. He described the mode of distingu ish ing

collections of fluid in the abdominalcav i ty from collections in cysts, and illus trated,from preparations in the museum , ovarian , renal,and hydatid cysts .We give the following remarks on combined I1:

ternal and external examination ofthe abdomenand pelvisWith the thumb in the rectum and the fore

THE CANADA LANCET.

finger in the vagina we can often get an accuratenotion ofwhat may be contained in Douglas’spouch or, on the other hand, i f the thumb is onthe cervix uteri and the forefinger in the rectum, i ti s quiet easy to feel a considerable part of the u terus,even to the fundus

,and so get a notion of its siz e

and form,or ofany thing attached to its exterior,

either in front , beh ind, or at the fundus.Simon

,of Heidelberg, laid great stress on the

combined examination ofth e bladder and u terusafter dilatation ofthe urethra, bel ieving that th iswas not only useful in completing d iognosis ofdisease ofthe bladder itself, but also for examininggrowths in the vesico uterine pouch , tumours onthe anterior surface ofthe uterus, or on either sideof the pelvis

,where they extend forwards . Com

bined exam ination between the walls ofthe abdomen and the bladder may occasionally becomenecessary. In someforms ofuterine disease combined examination may be assisted by previousdilatation ofthe neck of the uteru s with a spongetent ; and in other cases, where examination byrectum alone

,or combination ofrectal and ex

ter nal examination , may be insuffi cient, as in inversion ofthe uterus or congenital absence of thisorgan

,combined examination by bladder and

rectum,either by finger in rectum or sound in the

bladder, or finger in bladder after dilatation of

urethra,gives all t he information required but

this seldom can be necessary, except in cases ofatresia of the vagina .

As Hegar has pointed out, if the thumb ofonehand in the vagina fixes the vaginal portion ofthecervix uteri

,the index-finger of th e same hand in

the rectum can not only feel the posterior surfaceofthe uterus distinctly, but can follow the sacrouterine l igaments while

,if the other hand presses

the abdominal wall backwards towards the sacrum,

a very accurate idea can be obtained of the relationsof al l the pelvic organs. The uterus can be movedin various directions, and anyth ing between it andthe bladder or rectum is distinctly fel t

,supposing of

course no ex traordinary amount of fat in theabdom inal wall

,nor any pecul iar rigidity in the

vagina, interfere. Flexions ofthe uterus are thusvery accurately recog nised , and often replacedeasily.

“These examinations must be carried on,some

t imes with the patient on her back,sometimes on

her S ide , and sometimes in both positions, and occasionally in the knee-and-elbow position , with theShoulders low, a change of position ofthe organsgiving information otherwise unatta inable.Simon lays great stress on thefact that when

a patient is deeply narcotised the whol e hand maybe passed into the rectum . I have done this oc

casionally, but have not obtai ned much add itionalinformation than is given by one or two fingers.

“ Hegar deserves the credit of introducing amethod of exam i natIon which

,in some cases

,is

really ofvery great value. He fixes the’

vaginalz

portion of the cervix uteri by a pair ofl ong hooked :forceps

,by which the uterus may be drawn down

wards or on either side. The same obj ect may beobtained more safely by one ofMarion S ims

’

s»

hooks,and there can be no better method of clear

ing up doub ts about the siz e and position of theuterus, i ts connexion with neighbouring organs, and .

especially its relation with abdominal and pelvictumours .I need not say that this must al l be done with.

due care that no forcible traction upon the u terusmust be exercised , and that steadying the organ.wil l often be found quite enough .

Suppose the u terus thus fixed and gentletract ion made upon i t with one hand

,and one or

two fingers of the other hand are passed into the

rectum,the posterior surface and sides of uterus are

felt, and, i f necessary, the finger may be carriedover the fundus. Sometimes the forceps or hookmay be given to an assistant

,wh ile one or two

fingers ofone hand in the rectum and the other onthe abdominal wal l effect a combined examinationofthe most complete character. The connexionof the abdominal tumours with the pelvic organ smay be very accurately made out. A S l ight pulton the u terus may be suffi cien t to cl ear up anydoubts as to the connexion between the uterusand the tumour

,whil e the pedicle or membranous

adhesions with the rectum may be made tense andifelt.

“ Supposing a tumour is partially or entirely inth e pelvis, in more or l ess close apposit ion withthe uterus, by drawing the u terus d ownwards or

forwards on to one or other side, the examiningfingers in the rectum may follow the outl ines ofthetumour and notice how its movements are affectedby the movements ofthe uterus, or if i t may beseparated from th e uterus. I t is by no means unfrequent that you can separate the uterus from atumor where previously there had se emed to beintimate connexion

, or union apparently inseparable . The assistant drawing down the uterus or toone S ide, with two fingers in the rectum and theother hand over the abdomen , pushing up thetumour, we may often get an idea ofthe l ength ofthe pedicle, and in reference to uterine fibroids information as to the possibil ity of removing them .

You find out the length and thickness ofthe cervix,whether it is fixed or movable, and whether i t isinvolved in the new growth . You pull

,as it were

,

the neck of the uterus ou t ofth e mass which in ameasure involved it

,and th i s shows the tumour to

be a growth wh ich may be removed .

The lecturer then described the chemicalcharacter offlu ids removed by tapping in asci tesand in ovarian cysts

,reserving the m icroscopial

charactersfor the second lecture.In the second lecture

,delivered on Wednesday,

June 1 2th, Mr. Wells described the microscopial

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THE CANADA LANCET.

sergent de vi lle himself, such as h e is to be seen inthe huts along the Seine

,only instead ofresusci tat

ing the drowned man,he is giving a picturesque

description to a large number of people, who arelistening attentively

,and imbibing

,i t is to be hoped,

valuable rules,which will not be forgotten in

moments of emergency. He is showing them howthe bed consists ofa large hollow metal mattressfilled with water

,kept very hot by gaslights unde r

neath whilst another,a wool len

,mattress i s placed

on the top ofth is,and how the drowned man is to

be warmed. He points to the tub with the spoutsofhot and cold water

,and says how and when the

douches are to be used. He winds up with a descr iption ofthe rules and means which one canalways apply for resuscitating th e drowned

,even in

the absence ofthis improved apparatus,and directs

them to read the code of precepts hung up on thewall , which they do when they can understand thelanguage .

Another most interesting part of M . AlbertGigot ’s department consists of the fire-engines andpumps , and altogether the various apparatus employed by the

'famous firemen or sapeurs-ponzp iersofParis . The Parisian population take especialinterest in the visi t to this section. They areextremely proud of th is corps of sapeur s-pornp i ers ,who render invaluable services in more than one

way.

In th is Exh ibition ofthe City of Paris, so ful l ofsan itary aspects, and which attracts a large crowdanxious to study i ts various features

,the Ass istance

Publ ique , or general administration ofth e Parishospitals, occupies a very prominen t part. TheAssistance Publ ique has two pavil ions

,in which i t

has collected the most interesting specimens ofi tsvarious economical arrangements or hIS torie

records . In one of these pav il ions is a glass press,

the contents ofwhich would delight and absorbthe attention ofan antiquarian for more than aweek. It contains the most venerable documentsofth e H6tel Dieu

,going back to the twelfth

century, with the coloured parchment accountbooks ofthe pilgrims ofSt. Jacques , and othermanuscripts ofthe highest h istorical value . Hereare also to be found the uninterrupted annualseries ofaccount and budget books oftheH6tel Dieu, and other hospi tals through agesdown to our time. Near th is press is a case contain ing the surgical instruments which belonged tothe great Dupuytren , the surgeon to the H6telDieu . Indeed, almost the whole of this pavilion ,wi th the exception ofafew things

,i s consecrated

to the history and glory ofthe H6tel Dieu . Thewalls are hung with pictures ofi ts various ap

pearances and changes since i ts earliest foundation ,and with plans ofthe new building wh ich has replaced it.The other pavilion is a typical reproduction of

the wards of a Pari s hospital, or at all events of

th e arrangements concern ing each patient in award. Here is the bed with the curtains

,which

are now given up entirely in England and in othercountries, but are stil l i n favour here. However

,

if I understand arigh t M . Michel Moring ( th eDirector ofthe Assistan ce Publ ique) , a plan ofmovable paravm ts will be tried, as a substituteforcurtains

,in the new and model Hopital de Méni l

rnontan t. Here is the pancar te, or bill , stuck upat the foot ofthe bedstead— th e horribl e pancarte,for which there i s no excuse

,and on which are

related in full detail the name,religion

,age

,and

disease of the patien t. Here al so are to be seenthe typical specimens ofmattress, bedding, chair,table, utensil s , and , in fact, everyth ing employedfor each particular patien t in the Paris hospitalsnot to mention the surgeons’ cases ofin struments ,the table, stretchers, &c. In a word

,the obj ect of

the Assistance Publique i s to give th e visitor acorrect idea ofwhat is to be seen in hospi tal ward .

Between the two pavil ions is a very perfect model‘

of the lying-in pavil ion,which has been built up at

the lying-in hospital according to Dr. Tarnier’splans , and which is commonly known as Dr.Tarnier’s “ Model Pavil ion .

” It consists of aground-floor and first storey

,each containing four

bedrooms, which have no communicat ion betweenthemselves, and al l open from the ou tside. In thecentre ofthe rooms is an ofii ce looking upon thefour appartmen ts by means of a glass pane , so thata s ingle person can exert supervision over the fourrooms .

Between the two pavil ions are likewise to be'

found extens ive views and plans ofthe new Hopitaflde Mén i lmon tan t and the Maritime Hospital of'Berck-sur-Mer. These are worthy ofparticular attention . The Hopital Men i lmon tan t is in tendedto be a model hospital

,with all th e most recent

improvements in hospital hygiene,whils t Berck-sur

Mer is a realisation,and a most successful one, in.

France of the mari time hospitals which are exten s ively used in I taly for scrofulous ch ildren , andconstitute the treatment par excellence ofscrofulaand rickets.The D irection ofthe Sewers and Waters ofParis

has also been very successful in getting up a mostvaluable exh ibition in this pavil ion ofth e city.Models ofeverything relating to the sewers ofParis ,which are accounted so perfect i n their arch itecturalarrangements

,and are visited with intense curiosity

by al l who come to Paris,have been carefully

gathered and exhibited here. The l it tle models otthe large and small collectors and pipes built withrailways

,and intended to be swept and kept clean

by sweeping-vans , are exceed ingly perfect. So al soare the models ofal l the trucks , the vans, the rai l~way cars

,and boats which are used for floating on .

the sewer waters or gliding on the rails, and are

elaborately and ingen iously contri ved for the purpose of v i siting, repai ring, or cleansing the pipes

THE CANADA LANCET.

Another important part ofth is exhibit ion is theone tended to show the u til isation ofsewage. Thisoccupies one half ofthe gallery running round thepavil ion, and facing the Foreign Section . Hereare brought every day the huge cabbages

,po tatoes

,

and artichokes grown in th ep laines ofGennevilliers .Specimens offlourishing thyme

,sage, an iseed, and

angelica are also exhibited fresh,and a one-year

poplar ofsurpri sing growth dominates al l th isvegetable kingdom . These various productions ofa so il ofexuberan t fertil ity come from a placewhere formerly al l cul tivation was unknown on ac

count ofth e barren sandiness ofthe soil . Everything that can illustrate th is system ofutil isation isshown in maps, models, or original specimens . Theworks established for the construction ofthe pipesare represented . So also the forcing-pumps. Thefields ofGennevill iers are represented in a largemodel , with the trenches, the pipe orifices, theirrigating tubes, &C . Conspicuous on a shelf arethree bottles— one contain ing the th ick

,greasy stuff

called eau d’egouts , or sewer-water

,such as it is

brought to Gennevill iers the second,clear trans

paren t water which col lects at a certain distancebelow th e surface ofthe soi l after having fi l teredthrough the sand , and then retu rns to the Seineand the third, the residue ofthis fi l trat ion

,which

subsides in the trenches in the form ofa peculiarsand .

This Direction has had the felici tous idea ofexh ib i ting elsewhere a complete and graphic descri ption ofall th e great works which have beenundertaken for the purpose of bringing th e purewater of the Dhuys and the Vannes from hundredsofm iles into the capital , so as to supply its inhabitants with a perfect and rel iable type ofpotablewater. Abou t one-half of Paris is already providedwith th is inestimable boon

,which will soon be con

ferred on the other half ; and i t is really qu ite arel ief to the visi tor ofth is pavil ion

,after he has

examined the admirable sewer arrangements ofParis

,and the wonderful resul ts ofsewage at

Gennevill iers,to go and dream ofpure air and

water before the views ofthe green valleys ofDhuys and Vannes

,th e aqueducts through the

fores t ofFontainebleau, and other pleasant aspectsofwater collection and distribution .

Before leaving this pavil ion , so ful l of interest toa visitor concerned in hygiene

,I must at l east make

a passing reference to a very complete model , exhibited , I th ink, by M . Alphand

,and showing al l

the arrangements ofa portion ofthe Boulevards.Everyth ing relating to a house and street

,the

sanitary arrangements,th e getting and distribution

of air, l ight , and water, are shown with wonderfulprecision and correctness . This corner i s invariablycrammed with an eager crowd

,and I do not re

member ever having seen a more perfect,and , I

th ink , usefu l d escription ofthe arrangements ofahouse and the part played by air

,light

,and water

i n human existence — Lancet.

367

THE TR EATMENT OFPOST-PAR TUMH/EMOR R HAGE BY HOT WATER .

To Me Ea’z'

tor ofTHE LANC ET.S IR ,

— In the paper wh ich I read before theDubl in Obstetrical Society in December last

,on

the use of hot water in post-partum haemorrhage,and abstract ofwhich subsequently appeared inT/ze l ancet, I stated that I was induced to adoptthe practice in consequence ofth e representationsofDr. Whitwell, ofSan Francisco . I have sincereceived the accompanying letter from him , whichyou may th ink worthy ofpubl ication . I ts perusalmay perhaps induce others to give the treatment atrial.For myself, I can say that I consider hotwater inj ected into the vagina at a temperature of1 10

° to be a most effi cien t method ofcheckingpost-partum haemorrhage , and that i t is now carriedou t as a routine treatment in al l suitable cases inth is hospital .

I am,Sir,

Rotunda Hospital, Dublin , June 3rd . Master ofth e Hosp i tal.San Francisco, C al iforn ia, March 6th , 1878.

MY DEAR DOC TOR , -You ask for some information concerning the u se of hot water in post-partumhaemorrhage.While in the Woman ’s Hospital ofthe State of

New York d uring the winter of1 8 74-7 5 , in th eposition ofhou se-physician , I saw in the service ofDr. Emmet the hot water vaginal inj ections usedto great advantage in all pelvic inflammations . I twas also customary to order these inj ectionsforpatients who were to undergo any operation aboutthe vagina

,that the t issues might become blanched

and contracted, and thereby firmer. But on one

occasion I had the good fortune to see the almostinstantaneous effect ofhot water in control l inghaemorrhage in a case calculated to try its powersto their utmost. The patient

,a weak and very

anmm ic woman , had a tumour at the fundus of theu terus

,which caused almost continual loss ofblood .

Th is,which afterwards proved to be a sarcoma , was

partially removed by th e scissors,th e operation

being then suspended on account ofseverehaemorrhage . The patient was immed iately turnedon her back , and water at about 1 10

° was inj ectedto thefundus by means ofa Davidson ’s syr inge.After the first few syringefuls , the water came awayclear

,and there was no subsequent loss ofblood.

One drachm ofChurchil l’s tincture ofiodine wasthen thrown to the fundus

,and the vagina C arefully

tamponed with cotton,which when removed showed

merely a staining with iodine . I bel ieve that Dr.Emmet’s idea in using the hot water was to causecontraction of the womb, and so part ially controlthe haemorrhage , but that h is main reliance wasplaced upon the iodine.

THE C ANADA LANC ET.

A short time before th is I had heard Dr. Traskread an able paper on the dangers ofperchlorideofiron , and the use ofiodine as a substitute, incases ofpost-partum haemorrhage. The case abovecited and this paper fresh in my mind suggested tome the use of hot water in similar cases.I had no knowledge ofhot water having been

used by anyone up to th is time in cases ofpostpartum haemorrhage cold

,on the contrary

,being

advised by all teachers and textbooks on thesubj ect.My first opportunity to test i ts efficacy was at

Breslau l n August,1 87 5 , when , through the kind

ness ofDr. Landau, the assistant at ProfessorSpiegelberg’s clinic

,I was al lowed to accompany

h im to a case to which he had been called . Hefound that the haemorrhage was internal

,and that

the fundus was high above the umbilicus. Theuterus was cleared ofclots, and hot water inj ectedas best we could with the imperfect means , an immense G erman syringe , that we had at hand. How

ever, contraction took place so rapidly after thefirst injection that the midwife spoke ofit, althoughshe did not know why the flat water was beingused. The womb remained firm and contracted.

Two other cases proved to Dr. Landau its ap

p l icabi lity, and at the annual meeting at Gratz i n

September h e spoke enthusiastically ofth is l ine oftreatment. He was told that i t had been discarded long ago.

My n ext opportun ity occurred in the service ofProfessor Br

’

isky, in the Lying-in Hospital at Prag,where my statements were received with considerable incredulity by the assis tant

,and i t was with

some d iffi culty that I could induce him to use thewater hot enough , he being fearful of burning thepatient. The fi rst case was a success

,and since

that time it has been thoroughly tried and acceptedas th e best treatment, and a large number ofcaseshave been reported. Favourable reports also comefrom Berl in , and trials are being made in Strasburg,so that I was a l ittle surprised to see that the useofthat dangerous agent perchloride of iron is stil ladvocated, and that hot water is not even spokenof.

O

In only one case have I found the u terus failingto contract almost instantaneously. After performi ng craniotomy, wish ing to wash out thoroughly,and also to cause rapid andfair contraction

,I

passed my hand with the syringe into the uterus.I was a l ittl e startled

,after inj ecting a moderate

amount ofwater, to find that I could not touch thesides ofthe u terus . Fearing that I had failed

,I

was withdrawing my hand,when th e water gushed

ou t, and the womb had contracted firmly. I t wasthei1 apparent that my wrist had prevented thereturn ofthe water by obstructing the cervix

,and

that the uterus had in consequence become dilated.

Would i t be possibl e in a case of transversepresentation , th e l iquor ann i i having come

'

away,

Yours very truly,WM. S. WHITWELL.

To Dr. Lombe Atthi ll.— L m ‘.

ON THE ADMINISTR ATION OF IR ONAND COD-LIVER O IL.

The desirability, and,at the same time,

the difficulty, ofgiv ing the above remediessimultaneously must

,no doubt, frequently have

been experienced by every member of the profession . The difficulty consists in th is — Ifany ofthe commonly-used preparations ofiron , such asthe syrup ofthe iodide

, or the tinctures, be in anyway mixed with the cod-l iver o i l

,the well-known

and horribly nauseous flavour prod uced by the

to render the turning easy by the replacing oftheamniotic fluid by warm water?I shall be much pleased and deem it a favour if

I hear from you with what success you meet,for i tis an important subject

,and I feel sure that hot

water must soon supersede all drugs and medicatedinj ections

,being superior to them all in many im

portant particulars.1 . I t is easily attainable at all times.2. It is absolutely safe

,if care be taken to ex

clude air from the syringe .3 . I t stops haemorrhage, not by artificial plug

ging, but by causing a natural contraction oftheuterus .4 . I t is cleanly, and a disinfectant, such as

carbol ic acid,can be easily added.

1 5 . By imparting heat, i t rall ies the exhaustedpat ient

,and gi ves power to the musclesfor con

tracting,instead of, as is the case with ice, abstract

ing what l ittle heat remains, and so benumbing andparalysing them .

Can more be required ofan agent? . It i s mypractice to have a syringe and hot water always onhand. In case ofhaemorrhage the water i s used ashot as can be borne by the hand . I f, however, al lgoes well

,a vaginal bath is given at r oo

°F., andcontinued for several days n ight and morn ing. Afew drops ofthe s trong impure carbol ic is addedto the water as a disinfectant. This bath alwayssoothes and allays in a marked manner any inflammation and swell ing ofthe external parts. I tis a question how high a temperature can be borne,but I have known ofa patien t using water as hotasLet me suggest the use ofthe hot inj ection in to

the uterus for the hastening the removal ofth eplacenta and, again , if in any case ofhaemorrhageyou shouldfai l. to bring on contract ion , allow meto suggest the strong tincture ofiodine inj ectedwell into the fundus to prevent the too early contraction ofthe cervix, whereby there is risk of somefluid being retained.

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THE C ANADA LANC ET.

then carefully replaced the structures,and c lo sed IDIOPATHIC AMYLO ID . DISEASE OF THE

the incision by means ofwire sutures , over whichwas placed cotton wool steeped in carbol ic o il and LIVER ’ KIDNEY,

AND SPLEEN°

bound down by‘

plaster and covered by a pad ,whole being included by a spica bandage. I also (U nder the care OfDr' JU LIU S POLLOC K») C haring C ross

H os ital.at once ordered him an Opi um p1ll ( ry. gr.) e

p

four hours . For the following interesting notes we are inJ uly I 5th ,— r r A.M. Patien t on the whole p ro

debted to Mr. R obert Sm i th,M .A.

,M.E.

,med i cal

.gr ess ing favourably, although considerably ex regééi

l

rfir‘

D 1 b d t thansted. Slight tenderness over left ingu inal region , 1 1am ,a a ourer

,age wen y-si x years,

-was admitted on Feb. 9th, complaining chiefly ofd by pressure. The bowels have acted , weakness. He fixed the beginning of his illnesshaving ceased. Pulse 80 ; temperature

p .m . Pulse25 . Is 'in

\a

cts ofopiumeing contracted. Ordered -t tovery six instead ' of every fourand complains of tenderness in

Pul se 80 ; respiration 24;R espiration short and some

atic congestion ofbzi ses

,oflung was found ; bowels rather relaxed.

Ordered brandy,egg

, ,and m i lk mixture in half

ounce doses,every hour

,and half an ounce of the

following mixture to be taken every four hours'

:

Carbol ic glycerine,two

, drachms tincture Of op ium ,

one drachm d isulphate ofquinine, fifteen grainsdilu te sulphuric ac id

,one drachm water to .six i

ounces— 9 p .m . : Patien t much exhausted ; hastaken but l ittle nourishment. Pulse 1 00 ; resp iration 30 . O rdered turpentine fomentations to theback .

The subsequent progress of the case does not

call for much commen t ; the recovery was somewhat ted ious , but not complicated by any bowelm ischief or perit on itis . Sl igh t erysipelas took placeabout th e wound

,and a small abscess formed.For

some month s after the healing Of the wound therewas no tendency to hernia] protrusion

,al though the

inguinal canal had been so freely laid open subsequently, however, owing to the laborious characterofth e employment ofthe patient

,a considerable

protrusion took place in the site ofth e cicatrix.

R emarks — I bel ieve this to have been a casesim ilar to that described by B irkett in h is article onHernia , in Holmes

’s System of Surgery,a rent

having probably taken place in the posterior wellof th e sac, through which the intestine escaped into the subserous areolar tissue

,th e sac itself being

found lying in the inguinal canal,the constricting

part being formed by the neck Ofthe '

sac itself.That the intestine was in the subserous areolartissue, and not pushed back into the abdomen

,was

quite cl ear,‘ as i t was impossible to return the in

testine, without using undue force , previous to thedrawing down of the intestine and the divis ion ofthe constricting band — Lancet

, y um 22nd .

sembled the pouring of cold water on the spine.At , night, after the sh ivering, he sweated freely.The shiverings continued on and offfor a fortnight,but the patient continued to nurse his father untilh is death at Christmas . The father was said

.

tohave had enlargement ofthe l iver. Cough nowcame on , and the patien t began to spit tenaciousphlegm of a dark colour. He lost flesh

,and gra

dually,

grew weaker but after the first week or twohe was not feverish , and did not persp ire unduly.

About a fortnight before admission he once or twicefel t severe pain at the pit of th e stomach , rel ievedby taking hot gin-and—water and applying hot flannels to the abdomen . He had no other uneasiness

,

but . gradually got weaker, and h is appet ite dimini shed . His previous h istory was good .

’

He neverhad rheumatism or gout or any venereal affection .

He married very young,and had had a family of

four ch ildren,all quite healthy. He had not been

in the habit ofi d i inking spirits . H is bowels wereusually regular.

'

_

His mother died ofinabil ity topass gall-stones

,and used to ‘be jaundiced now and

then ; and h is father died, as j ust stated , of“ enlargement ofthe l iver h is father’s legs and feetswelled before death

,but he had never been jaun

d iced,and was very pale when he died . Patient

hadfour brothers and s isters al ive and well .On adm ission

,h e was a tall

,sparely-built yO

’

ungman

,w ith very pal e features and anmm ic mucous

membranes but he stated that he had alwaysbeen pale. He was suffering no pain

,and there

was only a slight cough . The even ing temperaturewas at which point i t continuedfor threedays thereafter. The pulse was about 1 00 . His

.

sk in felt qu ite moist,but there was no marked per

spirat ion at nigh t. He slept very well, and saidhis appetite was improving. The skin over hiswhole body was exceed ingly

'

pa,

le . Phys ical . examinat ion ofthe ches t revealed nothing of importance in regard e i ther to lungs or heart. Theregion ofl iver dulness was increased, so as toextend downwards half way between the costalcartliages and the level ofthe umb il icus . Therewas not any tenderness on pressure over the l iver

THE CANADA LANCET.

region , or anywhere over the.

abdomen . Thesp leen was al so found to be enlarged. He sufieredsometimes from flatulence. On the two sides ofthe ches t and abdomen th ere were a few smal lrounded papules

,sl igh tly ra ised above the l evel of

the skin , and ofa faintly reddish colour. Therewere also one or two similar papules on each arm .

On the 1 2th he passed s ixteen ounces ofurine, sp .

gr. 1 020, acid, and conta in ing on e twentieth part

ofalbumen , but no sugar or casts . Ordered milkand beef-tea diet . T0 take five grains ofiodide ofpotassium in

,sal ine

On the i 4th t he

fell to Thounces ofurine

,wh ich still contained a small

quantity Of albumen,but no casts . On the 1 6th

he complain ed ofsome soreness (ifth roat, the re

sul t offresh cold. His appeti te continued to improve. TO take five grains ofchlorate ofpotashin one ounce perchloride ofiron mixture threetimes a day.

On the 26 th the patient fel t much better, andwas not qu ite so anaemic. His temperature hadgradually fallen from the 1 5 th , and had been nor

mal for two days. He now passed about sixtyounces of urine i n the twenty four hours. I t stil lcontained a smal l quantity of albumen . The l iverand splenic dulness have dim inished in area .

On March 1 2 th th e patient continued to im

prove , and wen t out to dayfR emarks by Dr. JU LLU S POLLO C K.

—This case isone ofsome interes t, be ing apparently an ins tanceofid iOpathic amyloid disease ofth e l iver

,spleen ,

and kidneys . When first seen the great enlargement and “ rounding ofth e IYW I' was most remarkable

,and the exis tence of a sO‘iri ewhat en larged

S pl een and of albumen 1n th e urine makes i t prettyclear that the Spleen and kidneys were l ikewiseaffected . Contrary to expectation , the patien t began to get better from the moment ofhis coming

'

i nto the hospital,and before he left the liver was

scarcely larger than normal . and there was but at race ofalbumen in the urine . The cause ofth eamyloid change in th is case is qu ite obscure — T/ze

PUER PER AL ANTISEPTICS.

Th ree papers by Lange'

nbach , Schule in andR ichter, in th e Zez

'

tsc/zr z'ftfur G edufl s/z. mm’

Gym ,

report the extensive adoption ofantisepticm easures for the prevention ofpuerperal infectionin their respective hO Spi tals . R ich ter’s obser

vat ion s were made in the Charité Hospital , atBerlin , where, especially after complicated laborsinj ections into th e uterus were made for prophylactic pu rposes

,and were continued throughout the

puerperium . In all,about three thousand injec

tions were made. The carbol ic solution most

THE LONDON MEDICAL SOCIETIES.

l ivered,and per cent. among the cases in

which th e inject ions were used . Schulein , in th eUniversi ty Obstetric Cl in ic ofBerlin , in the winter '

semesz‘er of1 8 76-7 7 , treated two hundred and S ix .

ou t of twowomen imminj ections ofof' carbol icwhenever in

ofil ln ess among the two hundred and six, or 28per cent .

,the death s amounted to only seven; or

per cent . only one occurring from septic causes ,one in a woman on whom Cae sarean section hadbeen performed . Langep buch has s ince 1 8 78 employed drainage Of the puerperal uterus in order toafford a free outflow ofthe secretions. His experience shows that this treatment is quite innocuous . In one case, the drain remained n ineteendays i n utero. He recommends th is treatmentwhere septic infection already exists

,in order to

prevent a new invasion Ofseptic material ; andalso as a prophylactic measure when the casesseem to Offer a doubtful prognosis .

The most act ive medical societies ofLondonare the Pathological

,of which Dr. Murch ison i s

presiden t,th e C lin ical

,with Mr. Callender as pre

siding offi cer,and the R oyal Medical and C hirur

g ical Society , ofwhich Dr. West i s president .These

,as well as some others , hold their meetings .

in a finely-adapted hal l in Berners street. Themeetings ofth e Pathological have been of greatinterest oflate, because three successive meetings.have been devoted to the discuss ion of diseases of'the lymphatic system ; the specimens had , therefore

,a direct bearing on th e elucidat ion oflympha

denoma and leukem ia. The dis cussion was Openedby Dr. W ilks , ofGuy ’s Hospital , who showed the

original specimens from which Hodgi n originallydescribed the former affection . He was followedby Dr. Greenfield , who showed several specimensofth e disease in question , and asserted that thetypical Hodgin ’s d isease was at fi rst essential lylocal

,consisting in an irr itative overgrowth of some

normal lymphatic gland tissue,wh ich became infective, and spread to the other lymphatic glands

5372

and to the spleen and that the growths,the pecu

l iar anaemia and cachexia, and the rise in temperature

,occurring at a certain period of the disease

,

were the essential factors. During the three evenings there were many cases oflymphadenoma

,

l eukemia, and essential anaemia reported , and thesubj ect viewed in many ways, by such men asM urchison

,Sir Will iam Gull and Mr. Hutchinson.

The report ofthese d iscussions should make thenext volume of the Pathological Society’s Transactions ofgreater value than ever

,for i t is in this

debatable region that th inking men are now aux

fiously working. I was especially s truck with thee laborate preparation madefor the meetings

,which

c ontrasted so strongly with our own Pathologicalm eetings , where we so often see a mass ofSpecim ens which are accompanied by no ante-mortemih istory, and ofwhich we know l i ttl e until th e"Committee on Morbid Growth s reports

, two weekslater. Here i t is very different. As soon as Ientered the anteroom , I found a table on whichwere about two doz en microscopes exhibiting sect ions ofthe specimens to be presented during theevening. Again , while the papers were being read,we had m icroscipical drawings passed to u s to examine, as the reader reported what he found by

p ersonal inspection ofthe growth . I,at once

,

thought to myself,Here is the cause ofthe rep

'

u tat ion ofthe London Pathological Society’sT ransactions ; th is is the reason the older men do.not desert the meetings. I f one is sure of hearing

:histories ofth e specimens, and , at the same time,i s able to see the sect ions under the microscope

,

a nd make his own deductions,he feels that h e wil l

[be repaid for an even ing spent in the hal l oftheS ociety.

” The grouping together ofcognate subj ectsfor each meeting, as has been so widely doneby our own committee, i s also a most excel lentp rov1s1on .

The Clinical Society seems to cover a field“

rather different from any ofour Philadelphia socie‘

t ies, and to me i t was one of the most interestingland instructive. The papers which relate to clini~cal medicine and surgery are l imited in length toten minutes, which insures the discussion ofanumber ofcases every evening

,though i t unfortu

nately requires many papers to be hurried over ina very unsatisfactory manner. The character ofthe papers will be better appreciated if I give youthe titles ofa few recently read : “ R emoval of a

"Chip ofIron from the Crystalline Lens by a Powerful Magnet ; Cases ofR etin itis Haemorrhagica

“

in Connection with Gout ; Cases ofPleuralEffusions Electrolytic Treatment of Epul isBilateral Paralysis ofC rycoaryteno idei Pos ticiMuscles “ Plantar Bunion.

” At a subsequentperiod the following were to be presented : Ovariotomy in a Child aged Twelve years Woundofan Abnormal Obturator Artery, in an Operation.for Femoral Hernia.” The short practical paperv . 0 0 .

THE CANADA LANCET.

of th is kind is what the busy practitioner des ires.May we soon have in our own city a surgicalsociety or a cl inical society wh ich will fi ll thisposition in the eyes ofthe profession .

Speaking of th e Clinical Society suggests a casewhich I saw at one ofi ts meetings. I t was an instance ofpsoriasis , which had existed, to a greateror less extent, for twelve years . The man had beentreated by Mr. Hutchinson , experimentally withchrysophanic acid

,in the following way : The

d isease affected the trunk and arms especially, i twould seem

,and th e patien t was accordingly

ordered to u segointment on th e back and left

arm,while he as to apply a preparation of

chrysophanic acid to the chest and righ t arm .

When he was presented to the members oftheSociety

,after three weeks’ employment ofthe drugs

in question,his left arm and back showed numerous

red and scaly patches Of typical psoriasis, while theopposite regions were exceedingly soft and smooth ,though evidently not entirely freed from the affection . I t was certainly a very good demonstrationofthe use and effect ofthis n ew remedy of thedermatologist.The R oyal Medical and Chirurgical Society i s

another wel l known society ofLondon , and is wel la ttended. The papers are read by the secretariesand not by the authors themselves, which , to mym ind

,i s very obj ectionable. No author would

care to have a well-prepared paper read in a hungl ing manner by on e who, on account ofbad eyesor poor l igh t, comes to a dead hal t at frequen tintervals. I heard an interesting article, by Mr.Jonathan Hutchinson

,on what he proposes to cal l

Ophthalmoplegia Interna,because the symptoms of

the disease are'

palsy ofthe iris and cil iary muscles,without involvement Of any ofthe external ocularmuscles . The constrictor and dilator fibres oftheiris are both paralyz ed, and the pupil consequentlyremains unaltered

,the patient has no power of

accommodation , and requires convex lenses toe nable h im to read , while the muscles which rotatethe globe

,and the elevator ofthe lid retain their

functions intact. This group ofsymptoms, Mr.H . bel ieves to depend on disease- probably, as arule , syph ilit ic— oi the cil iary gangl ion , which , asyou know

,has a sensory root from the fifth nerve,

and motor roots from the third cerebral and fromthe vaso motor nerves. . He reported eight casesin which he bel ieved this to be the cause of

.thepalsy

,though no post-mortem record was posmble

in the cases,as th e disease is not fatal. The palsy

ofthe iris usually preceded that of accommodati on ,and was greater than the latter. The treatmentadopted was anti-syphilitic in character.

.

It i s

necessary,before coming to a diagnosis ofd 1sease

ofthe cil iary gangl ion , to assert that the paralyt1ccondi tion does not extend to the external ocularmuscles

,for then the cause must be behind the

point mentigned. On the same even ing the mm;J ~5 J 9 v

X

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THE CANADA LANCET.

THE CANADALANCET.

AMonth ly Journal ofMedi cal and Surgi cal S ci enceIs sued Promp t ly on th eFi r s t ofeach Month .

fl C om m u n i ca t i o n s s o l ici ted on a l l M ed i ca l a n d S cl

cn t iflc su bj ect s , a n d a l s o R

ep or ts ofC as es occu r r i n g i n

p r a c t i ce . A d ver t i s en w n ts n s er ted on th e m os t l i ber a l

t er m s . Al l L e t ter s a n d C om m u n i cat i on s to be a d d r es s ed

to t h e E d i tor C a n a d a L a n ce t ,” flor on to .

AGENTS .— DAWS ON B R os Mon t real J . A. MCMILLAN , S t . John ,

N.B . J . M. BALDW IN , 805 Broadway , New York, and BALLIER E,TINDALL & C ox ,

20K in sr Wi l liam s t reet , S tran d , Lond on , England .

TOR ONTO ,AU G . 1

,1 8 78 .

MEDICAL BILL.

The profession in England are much exercised

.at present in discussing the above—mentioned Bill,which has passed the House ofLords without ad ivi s ion , but has its fate yet to be determined in

t he House of Commons. Before making a few re

m arks on the subject ofMedical Corporations, wewill lay before our readers an extrac t from theLondon Lancet ofth e 1 5 th June, which will place

.t hem are warm ! Of its general features

Let there be no mistake abou t one poin t— i t isn ow a serious measure. There is no longer theweakly permissive character about i t which i t hadw hen it first saw the light. It is the gravest bit oflegislation in medical matters which has yet beenattempted. I t represents new powers in medicalm atters i t abol ishes many old ones. I t dealsv ery seriously with the great traditional functionsofthe corporations— that ofl icensing men to praetice it sweeps it away. Universi ties and corporartion s will be untouched with regard to the powerofgranting degrees or diplomas, but the virtue oftheir degrees or diplomas to procure admission tot he R egister, and the corresponding right to praet ice will be gone. True, Univers ities and Corpot

ration s wil l stil l be regarded as the medical authorities on whom will be devolved in the firs t instance the duty Offram ing schemes for appointingp ersons to act as a

'

boardfor examinations to bepassed

,in order to

'

get the qual ifying cert ificatewhich alone

,as far as British subj ects are con

c erned , i s to enti tle to registration . But althoughthey are invited thus to frame schemes , the schemeswil l be framed wi thout their consent if theyfail toact, and from the present form of the bil l i t doesnot appear to be certain that the persons passingthe conjo int Board will be brought. into any essent ial relation or subj ection to th e exist ing corporations and other medical au thorities . The B il l willm ake a grand difference to the several medicalauthorities

,

“

and over all ofthem, and over theM edical Council, will preside more decidedly thanhitherto

,th e Privy Council , to which schemes have

to be referred and by which they have to be approved : and which has the power, according toclause 7 , of ordering the Medical Council to recogniz e Foreign and Colonial diplomas , which afterdue cons ideration

,i t has refused to recogniz e.

We would in l imine state that the fears enter

tained by our brethren in England, that the sur

render by the Universities and various l icensing

bodies, ofthe right to practice, accompanying thedegree

, or l icense, would, in a large number ofihstances

,lead to the students being satisfied with

the l icense of the Medical Council,find no endor

sat ion in th e results Ofa similar surrender by Univers ities and Colleges in Ontario some ten yearsago. Cases of students being satisfied with thelegal righ t to practice conferred by th e l icense of

the Medical Council,and fail ing to take the degree

of M . B . at one of our Universities are so rare,as

to be quite the exception to the rule. On th e contrary a large number are to befound who are notsatisfied with the Baccalauréat ofone University,but become graduates ofboth Trinity and TorontoUniversity, many afterwards repairing to Great

Britain, from whence they return with an affix ofletters ofthe alphabet to their name that is certain ly amusing, if not imposing. That a thorough

change in the profession in England will take place

is pretty generally admitted. The most influential

ofthe medical j ournal s are openly and manifestlysupport ing the cause ofj ustice

,and there is no

question that sooner or later the soughtfor changewill pass the House ofCommons . The question

principally agitating the members ofthe professionis,what is to be done with the Universities and

C orporations ? The editor of the M ed ical P ress

and C i rcular for the 3rd OfJuly, saysUpon the two chief aspects ofthe subject

there is among the profession and the public,an

overwhelming concurrence ofopin ion . Every one,save those who profit by the diploma trade

,feels

that reform is urgently needed,and that conjoin t

examination is the only method ofreform which ispracticable under existing circumstances . Everyone , save a very few ultra radicals, is Of opinionthat the licensing corporations are deserving ofbeing protected and preserved, and that LordR epon ’s clause must be abrogated or modified,so as to ensure that l icensed practitioners shallalso be diploma holders .”

We grant that an abrogation of the privileges ofthe various corporations ofGreat Britain whichhave done so much in the cause of Medical Sci

THE CANADA LANCET.

ence, i s a measure to be very seriously considered,even supposing it nece ssary to Medical R eform ,

but fortunately it i s not necessary.For Ontariowe have had in operati on for a number ofyears, aMedical Bil l that has certainly not been found

ruinou s to the in teres ts of the Universities and

Medical Schools . Th ey have a representation ofeight members in th e medical council

,and the

general profession repre sented by territorial mem

bers . If the Engl ish College Council s are not

u tterly infatuated they wil l adopt some such com

promise, and we heartily wish they may, as we certainly have no sym pathy with the cry Delena

'a es t

C ar thage.

” We would have less scruple in joining

the attack against th e Apoth ecarie s ’ Company,as

we consider they have far less claims to the inviolab i li ty _

ofcorporate privileges. There can be no

question that the spiri t ofthe Apothecaries’ Actof1 8 1 5 was most grossly perverted by the C ompany, and taking a dishonest advantage of an over

sigh t in the Legislature, th ey have for years lorded

it over the profession . I t i s true that in the timeofR idou t, Wheeler, R andall and others, a Verysuperior pre liminary and medical curriculum was

establ ished, th e examinations were thoroughly

practical and comprehensive, surpassing even those

ofinsti tut ions of far greater pre ten sions,never

theless the rights and existence ofth e Apothecaries,

as a trading company,were qui te incompatibl e

with the profession . B arristers,Attorneys

,and

Law Stat ioners, migh t with equal propriety coal esce .

INJUR IOUS EFFECT OF MER CUR IALAMALGAMS AS TEETH FILLINGS.

Our atten tion has been drawn to this subj ect bythe many cases which are constantly occurring in

practice illustrative ofth e evil effect ofthese fi l l ingsupon the system amounting to a slow process ofpoisoning. Amalgams of mercury with silver

,gold

,

l ead , tin and bismuth have been used for th e pur

poses offi ll ings for teeth , th e il l effect ofwhich up

on the heal th ofpersons so treated is,we fear

,not

appreciated as i t should be.

The subj ect is one upon which much discussionhas taken place during the pas tfew years

,among

members ofthe dental profession,and although

its use as a fi l l ing has been pretty generally

d eprecated on the ground of its inj urious influence

upon the health, i t i s sti ll in use by some. Neither

the practitioner using it,nor the public can be at

al l al ive to the heal th des troying influence which i t

is capable ofexe rting. A due acquaintance however

,with th e chemical

.

nature ofsuch fi l l ings and

the physiological effect ofmercury upon the con

sti tution should be al l that is neces sary to determine

the attitude of any practitio ne r towards i tA writer in the C hicagoMedical y oum al in 1 8 74 ,

charges “ Amalgam plugs with b cing capable ofgenerating corrosive sublimate in the mou th through

the action ofthe chlorine in the fluids ofthe mouth.

He says , the symptoms are so n umer ous and.varied

in different cases, that i t would be imposs ible togive them all , but I will say that a person poisonedin th is way is l iable to be treated for dyspepsia

,

neuralgia,paralysis, throat affection and con sump.

tion , the patien t gradually was tes away as i f going

into a decl ine . In many cases the difficul ty steal son so gently as not to exc ite the least alarm . There

is a haggard express ion , a metal l ic tas te in themou th

,afoeted breath and excessive flow ofsal iva.

I have not time to detail the ma nner in which the

corrosive subl imate is formed in the mouthfurtherthan to say that the qu icksilver i n the plugs i s

driven offby the heat ofthe m outh, or any sal ine

substance,such as our food , pas ses into the stomach

and produces slow poisoning.

Instances ofthese effects have been met w ith inalmost every physician

’

s practice, and yet th e realcause may have been over looked. Many a delicate

lady owes her ill h ealth to th is very source,and

nothing wi l l suffi ce as a remedy short ofcompleteremoval of the obnoxiou s material . The con

stitut ional effects ofmercu ry upo n the system are

not by any means confined to the mouth,and th e

dose necessary to their production.

is so very

variable that the ir m inuteness would be almost ihcredible ifmentioned.

Piggo t,i n h is work on the “ chemistry and

meta l lurgy,”ofdental surgery says of

.

th is mercurial,

“ to the chemist th is question has but one side ; i t

needs bu t to be stated to be immediately decidedupon . The use ofa mercurial amalgam is underall circumstances wrongfor th e simple reason thatwe have no guarantee that the mos t frightful resul tsofmercurial poisoning will not take place.”Why incur so great a risk as is impl ied in this

mercurial poi soning ? The consti tutional effects ofmercu ry, are too well known to require mention,

THE CANADA LANCET.

and there can be no good reason for i ts use at al laside from its facil ity ofintroduction . The intro

duction of so virulen t a poison into the system

even in any form renders i t possible for i t to be absorbed in the slow way above indicated is radicallywrong and should not be ventured upon if the

patient’ s welfare is to be considered .

Our object in referring to this matter is in orderthat the profession generally may be aroused to th e

importance ofusing their influence against its use,

and that many who are now the victims of slow

poisoning from the presence ofthis drug '

in the

mouth may be rel ieved by its prompt rem oval,and

the substitution Ofsomething harmless if necessary.0

HOSPITALS, G OVER NMENT ESTABLISH

MENTS .

I f we could have entertained a doubt that th e

views ofmedical advancement,that we have from

time to time promulgated in our pages, were those

ofth e profession at large, particularly as regardsHospitals as Practical Schools of Medicine, th e

subj oined resolution unanimously carried at the

last meeting of the Medical Council,would have

been suffi cien t to have assured our mind on th e

subject.Moved by Dr. R oss , seconded by Dr. Clarke,that in the Opinion of this Council, the time has

now arrived when the General Hospi tals now in

operation in Ontario,and such as shal l hereafter

be establ ished , should be placed upon a govern

ment basis,similar to that provi ded for our Insane

Asylums,so as to give anassurance to the sick poor

in our midst that their wants and appl icat ions are

duly respected,and also to equally distribu te the

onus of their support over the whole community,and that we do earnestly recommend our profess ional brethren throughou t the whole country to

urge upon the individual legislators, and through

them upon the Legislature, the absolute necessity

which does exist for such provision being made.”

I t should be remembered,that in them , all the

accidents and diseases, which i t i s the glory ofourprofession to rel ieve

,are accumulated for the

purposes ofthe purest charity, for the enlargingofthe domain of science by the most eminentpractit ioners of the day

,and' what is of equal im

portance to the publ ic, for the instruction of the

numerous students,who are afterwards to d ispense

their skil l and knowledge in a thousand d ifferentchannels. I t may be argued that the great Hos

p itals in England are not supported out ofthegeneral taxation ofthe Kingdom .

’

True, they are

not the gift ofthe state bu t how widely differentare the circumstances, without for the present

taking the trouble of attempting minute enquiryinto them , we conce ive we are authoriz ed in our

statement,that a very large portion ofthe funds of

every Hospital in the C ity OfLondon , is deri vedfrom fixed and permanent funds

,and that the free

gifts alone ofdeceased benefactors would go a vastway in maintaining them in their present effi ciency.

Besides,as to their floating income

,much , very

much indeed,ofthat is derived from the publ ic

spirit and generosity —to lay ostentation aside

ofpersons ofeminent station , who consider theyowe a duty to society, for the protection it affordstheir wealth and rank

,to contribute to the main

tenance ofpubl ic charities . These persons are not

l ikely to be influenced in the management oftheHospitals

,or in the appointment ofMedical

offi cers . In th is country we lack the element

necessary for dispensing with state support,viz the great hereditary weal th Of the aris tocracyand landed gentry

,and the vast acquired weal th of

mercantile millionaires,to be found in every city

Of the United Kingdom . Our Hospitals therefore,have in a great measure to be supported by the

payments ofthe patients, payments, i t is true , fixedat a very low rate

,but in many instances we

.

ap

prehend,met by suffering or great self-denial on the

part of the family. The yearly grants from the Gover

nment and the very liberal , in some instances mun ificien t donations of private individuals, provinginsuffi cient for the exigencies of the charities, if theyare to be in any way conducted on a scale com

mensurate with the needs ofthe various cities inwh ich they are s ituated

,both as regards the number

of sick poor,and as schools and theatres ofmedical

science. Viewed in the latter l igh t, Hospitals asintegrant parts ofthe great / republic of medicine,should

,we conceive

,be considered as most im

portant parts of medical pol icy, and subject to laws

devised by the profession for their good government.

Some of these laws we would in this article venture

to suggest. With every disposition to concede toHospital Governors

,a fair meed ofpraise for their

z eal and impartial ity in the general management of

https://www.forgottenbooks.com/join

378 THE CANADA LANCE’

I‘

.

DR . C OVER NTON, late ofSimcoe, a fortnight agowas made the recipient O f a very flattering addressfrom the inhabi tants ofthe County ofNorfolk,beautfully engrossed, with an accompanying costlygift.

WE would be much obliged to Drs. CanniffandMcFarlane, if they would favour us with the

manuscript oftheir excellent papers on Diphtheriaand Puerperal Convulsions for publ ication in Sept.number.

APPO INTMENT.— Dr. G rasett has been appointed

one of the attending physicians at the hospital,

vice Dr. Temple,resign’ ed.

MEETINGS OF THE TOR ONTO MEDICALSOCIETY.

TORONTO, May 30th , 1 8 78.

The Society met at the Canadian Institu te,at

th e usual hour. Dr. Workman took the chair.The minutes of the last meeting were read and

adopted.

Drs . Dan iel Clark and Charles Clark were thenduly elected members of the Socie ty.

Dr. Pyn e proposed Dr. Laing as a candidate formembership. Dr. Fraser seconded the nominat i on .

Dr. G rassett then presented a specimen of cirrhosi s Of the l iver and enlarged heart

,accompanied my}; and am 1315.

by a short account ofthe case. A discu ssion en5 g 1711

sued as to the causation Of cirrhosis.INSAN ITY AND ITS PREVENTION , BY DAN I EL HDr. Z immerman then presented a specimen of

thrombosis of the longitudinal s inus,together with TU KE‘ Wi l l i ng “Wi ll i amson.

f h'

notes ofthe case. The longitudinal s inus was Want Of space W111 prevent.

noti ce 0 t 13

fi ll ed with coagulated fibrine.

add i t i on to our l i terature ofinsan i ty, i n the presen tDr. Canniffthen read the paper ofth e evening ; number, a rev i ew ofIt by a di st i ngu i shed special i s t

the subj ect was diphtheria. A long and interesting W111 appear 1“ our numberfor September.discussion followed as to the cause of the disease

, BRAIN ; A JOURNAL op NEUROLOGY. Edited byand as to the relationsh ip which i t bears to some Drs. Bucknell , J . C richten ,

Browne, Ferrier andother diseases J . Hughlings Jackson . Part i , to b e publ ishedOwing to the length ofthe discussion on Dr. quarterly : Wi ll ing Will iamson .

«

Canniff’s paper,Dr. C overnton postponed the

reading ofhis until the next meeting.

I t was moved by Dr. G. Wright and seconded

Wil l be noticed in September number.

by Dr. Pyne,that the discussion on diphtheri a be fiirflta, &amagtfi, t hfi.

resumed at the next meeting, after the reading ofDr. C overn ton ’

s paper. —Carried ,At Glencoe

,July i sth , the Wife ofW. E . Qu i n

An informal conversation then took place as to ley, M.D. Of a daughter.th e fu ture place of meeting ofth e Society. Dr.Canniffexpressed his willingness to aid the mem In Ph i ladelph i a, on th 1 9th

.

ofJune, G. Haybers in that matter

,and report to the Executive ward Coburn , M .D .

,ofFrederi cton , New Bruns

Committee.

wick,to Miss Mary M . Gamble, ofPhiladelphia.

The Society then adjourned.

a

At 168 Jarvis Street, Toronto, R . Burrington

J .WOR KMAN

,M.D .,

Nevitt,Surgeon North West Mounted Pol i ce, to

President. Eliz abeth R ,daughter of R obert Beaty.

Thursday,I 3th June, 1 878 .

At 8 o’clock , p .m . , the President took the chair,and th e meeting was called to order.In the absence ofthe recording Secretary, the

corresponding Secretary was directed to take theminutes

,and the reading ofthose oflast meet

ing was postponed.

No specimens were on exhibition,so Dr. C ov

ernton proceeded to r read his paper on Chorea,The paper was il lustrated by two cases ofhystericalrhythmical hemichorea, one from a cl in ical lectureofCharcot’s, publ ished in Le Progrés Medical , theother from Trousseau . A short discussion on thesubj ect ofthe paper then ensued, and a vote ofthanks to the reader was passed.

The discussion on Dr. C ann iff’s paper on Diphtheria

,read at the last meeting, was then resumed ,

and Dr. Canniffbriefly replied .

Dr. McFarlane announced that 'he would reada paper upon Puerperal Convulsions

,at the next

meeting,and Dr. O ldwright stated that he would

at the same time bring forward the his tory of somesuch cases which had fallen under h is observation .

Dr. Burns gave notice of a motion to the effectthat the interval between the meet ings of theSociety should be increased from two to threeweeks

,during the months of June, July, August

and September. The notice was laid upon thetable.Dr. Canniff then reported upon his efforts to

obtain a suitable room for meeting in , and theSociety adj ourned.

INDEX TO VOL. X.

PAGEAbdominal Tumors , Lectures on Diagnosis and Treat

men t— S pencer W ellsAccoucheur. com ing duties of

Hyd robrom ic

Acid , S alicylic, in Acute R heumatismAcid , S al icylic, in DiphtheriaAcid , S alicylic, in Mal ignan t S carlatina.

Acid , C arbolic, Po ison in from ,by J. H. R yan , M .D

S al icylic, danger ogin K idney Di sease .

O O O O O O O O O O O O O O O O O O O O O O O O

O O O O O O O O O O O O O O O O O O

Acid , Hydrobrom ic and Quin ine, in sedative doses .

Hydrobrom ic, in C erebro-S pinal Men ingitisAcne Brom ine

,R emedyfor

Address delivered before the Bathurst and R ideau Med ical Association , by J. A. G ran t, M.D. ,

Ed in . , O ttawaAdm in is tration ofI ron and C od-liver O i lAlimentation in S urgical Diseases— Ham iltonAmyl Nitri te , Therapeutic uses of.Ambulancesfor HospitalsAmputation at Ankle— Sym esAnchylos is ofH ip, Adam ’

s operation.

Anem ia and C h lorosis , d ifference betweenAneurism , Esmarch

’

s bandage in

Anem ia, local , prod uction ofin treating d isease oftheextrem ities I 7 I

Anem ia, progress ive pernicious 1 76Anuria lasting twen ty-five days 18 1Another Volume 23An imal Vaccine Virus 26 a. .

Anasarca, d rainage in . . 29An eurism , Popliteal— Esmarch

’

s bandage in 49Aneurism cured by S hot-bag 59Antiseptics , Puerperal 37 1Appo intmen ts 32, 64, 94, 127 , 157 , 222, 255 , 286, 378Arsen ic, Hypod erm ically, in Asthma 22 1

Artificial R espiration , Direct Method . 86, 334Aspirator , handy, by S . F itch

,M. 166

Asthma .Nervosum , treatment with Arsen ic and Galvanization ofthe Vagi

Atropine in Night Sweats .Battey

’

s O perationBelmon t R etreatB il ious and Typhoid Fever, C ases ranging be tween , by

Alex. Bethune, M .D. , W ingham , O ntBilious AttacksBilious Attacks ofS pringB ladder , C atarrh of, Potash C hlor.Blindness , S imulated , O ne-s ided , by A. Alt, M.D

230Blood C orpuscles , R ed , Nuclei in 18 1Bogus Diploma business . 95Bone, New Formation after R esection 326Book Notices 3 1 , 64, 96, 127 , 157 , 190 ,

223-4, 286

-8,

350, 378Bow-legs , treatment ofi n C hild ren .Brain InjuriesB rain Hygi eneBreach Presentations , managemen tBrewery G rains asfoodfor cowsB ritish Associationfor advancement ofS cienceBritish Med ical C ouncilBritish and Foreign Med ico-C hirurgical R eview ,

suspens ion ofBritish Med ical B ill

Bronchiectas is , treatmen t ofBurn s and S cald s , new remedyforBurn s, S oda B icarb . in

Buboes , abort ive treatmen t.C atheter, Ind ication sfor useC alcium , Muriate, in Tuberculos isC anada Med ical AssociationC anc

(

e

)

r ofS tomach , by G B Mott, M.D. ,Petrolia,

nt

C ard iac Disease , cases of— PepperC alculi , Multiple, PerinealC aesarean S ection Braxton H icksC aesarean S ection after DeathC hancres , Excis ion ofC hemistry ofC ommon LifeC hlorofo rm

,test ofpurity

C hloroform , DeathsfromC hloroform ,

Death from , averted by Amyl Nitrite.

C hloroform Narcos is , changes ofPupils in .

C hloroform , protracted S yncope und er.C hloroform , S ubstituteforC holera Morbus and Diseases ofS ummerC hloral Hydrate in Delirium TremensC inchon id ia S ulphateC inchon id ia S ulphate as an Antipe riod i cC irrhos is ofthe Liver— Loom isC od -liver O i l , S ubstituteforC old Drinks, makingC ollege ofPhysicians and S urgeon s , O nt. , Exam inationsC olon ial Med ical DegreesC ol lod ion Flexile in EczemaC olles ’ Fracture treatmentC omparative LongevityC on tagium Vivum theory .

C ontagium Vivum , doctrine of.C ontag ion , Theory of. .

C onference with Am erican Med ical Association256, 286,

C roton -C hloral and i ts usesC roup, treatmen t by S wabbing the LarynxC yst, Hepatic, C lin ic— G aillard ThomasC ystitis , Irrigation in C hron icC OR R ESPONDENC EEx C oncesso

Med ical Profes sion in Michigan— O bserverHysterotomy— Dr. C larkThe Tyranny ofa False S entiment .W . H . H ingston , M.D. ,

Montreal .G reat W estern R ailway Med ical Tariff.Lead , Acetate , in Post-partum HemorrhageS ulp hate ofC inchon id iaF . Broughton , G . W . R . , Ham ilton .

Absence ofAnus and Perineum— Dr . Tow ler.Ether i n S uspended An imation— Dr PowellLarge S tone— Dr. D. W LundyThe C on tract SystemAffi liated Med ical S choolsG . W . R . Med ical TariffMed icusPiliferous S ebaceous C ystR es R ara Adm i randaA Queer case ofMidwiferyMed ical W itnesses in Police C our ts.H . B . Baker, Lans ing

Deafness , Trephin ing Tympanum i n

Death-rate, Mon treal

INDEX TO VOL. X.

Degrees, British Med ical and C olon ial pretens ionsDelayed Ligature ofthe Fun is .

Diabetes, Diet and Med ication inDiabetes , S alicylates in .

Diphtheria and D iphtheritic C roup , Practical O bservations on the treatment, by A. H . C hand ler, M.DDorchester, N. B

Diphtheria, S yl icyl ic Acid inDip hther ia, Prognosis and treatmen t— Sm ithD iphtheria, Tracheotomy in .

Diphtheria and i ts treatmen tDiphtheria, Blood inDiphtheria, nature and treatment, by Wm. S loan , M.DBlyth , O nt

Disease, G erm s of.D islocation ofH ip, New Method ofR educing . 2

Dislocation , two uncommonform sDysen tery, Ipecac. in large dosesDysentery, local treatm en tDyspepsia, treatmen t ofEczema, C ollod ion Flexi le i n

Elastic Bandage i n U lcers ..

Electrolys i s i n S crofulousEmpyema, S urgical treatment .Empyema, C arbolated Iod ine in , by T. Fulton , M.D

M.R .C . S . , Toronto 34Em erald G reen , poi sonous effect of 188

Endocard itis and Pericard itis— Flin t 7 7Ep ithelioma ofC ervix U teri 1 18

,1 72

Ep ilepsy, Brow n-S equard ’s treatment . . 3 12

Epilepsy, Iron in 1 76

Ep ilepsy, Mean s ofpreven ting attacks— Brown-S equard 270

Ether as an Anaesthetic 8, 62

Ether, Death sfrom 156

Ethyl Iod ide i n Asthma 3 1 1

Exam ination s— Trin i ty Med ical 284— McG i ll C ollege . 285-B ishop ’s C ollege 285

— Queen ’s C ollege 285Fever, ranging between B ilious and Typhoid , by AlexBethune, M .D W ingham , O n t .Fistula, R ecto and Vesico-Vag inal, C losure ofVulva .F istula, R ecto-Vaginal operationFoetal Auscultation ,Discoverer of. .Foetus , effect ofmedi cines on

FoeticideForcible Flexion i n Fibrous Adhesions, by J. G ardner,M.D. ,

Hespeler, O nt.Fracture ofC lavicle , New Method oftreating , by HVan Buren , M.D. , C hicago, U . S .Fracture ofFemur, treatmen t— Ham iltonFracture, C auses and treatmen t ofDelayed U n ion , byJam es C attermole , M.D London 193Fracture ofS kull, Depressed , Trephin e i n 85Fracture ofFemur , Impacted 247Fracture ofthe Neck ofFemur in Adul ts—Hami l ton . 268Fracture, U nun ited , R esection in 2 74Fracture ofFem ur in C hild ren . . 278Fracture ofPatella, New operation 3 1 1

G alvan ism ,D iseases i n which usefuL. 88

G anglion ,treatmen t of 308

G en ital Irritation , a cause ofNervous Diseas e, by G eo.

M . Aylesworth , M .D . , C oll ingwood ,G landular Swelli ngs , treatmen t .G oitre, Iod ine injections inG overnmen t Estab li shm en ts , Hosp i talsG out, Benz oate ofLithium i n .

G out, S alicylic Acid i n

G raves’ 5 D isease (Exophthalm ia)G rowth i n the Human Fam i lyHaemoptysi s , Ergotine inHead , Injuries of— Erichsen "

Health R esorts , Elevated Position sHealth R eport, New York

O O O O O O O O O

0 0 0 0 0 0 0 0 0 0

O O O O O O O O O O O O O O O O O O O O O O O O O

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

O O O O O O O O O O O O O O O O O O O O O O

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Heart D isease , C lin ic— FlintHeart, Fatty Degeneration ofHepatic C yst, C lin ic— G ai llard Thomas .

Hern ia, S crotal— Jackson (McC arthy)Hernia, The Authors who wrote on it and i ts treatmentp rior to the 18th C en tury, by J. R . Alexander, M .

D. , Montreal , QueHern ia, C omplicated with Malposition ofthe Tes ticle,by V. A. Brown , M.D

Hern ia, S trangulated Femoral, by W . N. C ampbell,M.D. , New York

Hern ia, S trangulated Inguinal. three cases— S ac not

O penedHeroic C onduct R eward edH ip Dislocation , New Method ofR educin g .

H ip-jo in t D i slocation , Easy Method ofR edu

H ip Disease i n C hi ld ren , Diagnosis of. .Hoarseness , Borax and Potassium Nitrate inHoarseness, Nitric Acid inHomoeb paths in Diffi cul tyHoney, PoisonousHosp ital s , G overnment Estab lishmentsHospitalfor In sane, HalifaxHouse Drainage, Defects ofHot Water Treatmen t in Post-partum Hemorrhage

Lombe Athil l (Whitwell)Hyd rocele, Alcohol in treatmen tHyd rophobia, Bu isson ’

s C ureforHydrothorax, C lin ic— Flin tHOS PITAL R EPOR TS, TOR ONTO

Typhoid Fever , PerforationInguinal Hern ia in a FemaleVes ical C al culus , LithotrityPerforation ofthe S tomach 1

Idi opath ic Amyloid Disease ofthe Liver, Kidney and

S p leen— Julius Pollock 370I liac, External, Ligaturefor Aneuri sm . 4I leum , Intussusception of, byW . A W illoughby, M.D. 97Improper R egistration 1 25Insurance C ompan ies, Imposition of 87In testinal Obstruction , Enterotomy 107Infan t Mortality, C ause of 1 16

Intra-U terine Med ication, by J. C attermole, M .D 323Injurious Effect ofMercurial Amalgams as Teeth

i ngsInexped iency ofPhysicians Dispensing DrugsIod ine, C hurch ill’s TinctureIodoform , Therapeutic uses ofIpecacuanha, Large Doses in Dysen teryIron ,When not to give— Fothergil l .Iron , Dialyz ed , in Arsen ical Poison ingIron in EpilepsyIron , Dia yzed , in Arsen ical Poisoni ng, by Jas. Hayes,

M.D. , S imcoe, O n tIron , Dialyz ed , Hypod erm icallyIron and C od-liver O il, Adm in istration of.Iron , DialyzedIron , Album inateIvy

-

poison and i ts R emed iesJefferson Med ical C ollegeKeep the Mouth C losedKidney, IIydatid Tumor R emovedKidney, R emoval ofKnee-join t, Ind icationfor DrainageKnee-join t Amputation .Knee-joint, Aspiration of.Labor , Anaesthetics inLactopep tine

Lady DoctorsLady with Two Head sLady Practitioner in DisguiseLaparo

-Elytrotomy as a S ubstitutefor C aesarean S ec

t i on

Laryngograph

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INDEX TO VOL. X.

S alicinefor C hillsS an i tary Board sS an i tary C omm ittee , Legislative 103, 359S ensible R emarksS carlatina by LetterS carlatina, PuerperaS carlet Fever, R estriction and Preven tion ofS ciatica, Actual C autery in .

S cirrhous C ancer ofthe R ectum ,by Thomas S . Bar

clay , M . D. , Detro itS cirrhus ofBreas t in the Male .

S crotal Hern ia —Jackson (McC arthy) .S hould er Dislocation

,New Method ofR educing

S leeplessness and i ts treatment. .

Small-pox, HemorrhagicS ore Throat, treatmen tS pencer W el ls, R es ignation of.S pleen , Excision ofS p lints , PaperS tenosis ofTr icuspid O rifice— HowardS tomach

,Perfora ting W ound , R ecovery

S tone in the B ladder, S urgical treatmen tS tone ofB ladder , LargeS tone , C uttingfor , Three C entu ries agoS trabism us and i ts O perations , by A . Alt, M .D. . TO

ron toS urgery , Pas t and Presen t— Wells .

S yphilis and Marr iage,Talapes , Plas ter C asts in , by Dr. Burrows, Lind say,

O nt 356Talking Machine 3 19Tearless Mad ness 182

Teeth Fillings , Injur ious Effect ofMercur ial Amalgams 375Telephon ic Auscultation . 220

Tenemen t Houses, In spection of 25Tetanus , treatm ent of— W ood 83Tetanus

, Traumatic, by Dr. Lawson , Halifax 24 1

The late Dr. Hodder. 254Therm ometers first used 62

Thoracen tesis , R ecen t C ases 1060

Thrombo tic O cclus ion ofC oronary Artery 279Thrush , treatment of. 127Thymol as an Antisept ic 254Tobacco , Po ison ing w ith 142

Tons ils , Excis ion , Arrest ofHemorrhage 85Toronto Asy lum R eport . 252Toronto G eneral Hospital 252Toron to Mortal ityfor 1877 . 253Toronto Med ical S ociety 284, 3 15, 378Toronto S chool ofMed icine— Annual Dinner 126

Tracheotomy, Blood lessTracheotomy

,New Method

Tran slationsfrom Fore ign Journals.Tr in ity Med ical S chool— Annual DinneTrin ity C ollege C onvocation ,

Trin ity Med ical S choolTrinity Med ical S chool C ouncil R epresen tationTumors, Abdom inal, Lectures on Diagnosis and Treat

m ent— S pencer W ells 363Tumor ofLower Jaw , R emoval W i thoutExternal Wound 84Turkish Army Med ical S erviceTyphoid Fever, C onvulsion s in— DaC osta.

Typhoid Fever , C ontag ion ofTyphoid Fever, R enalformTympanum , Treph in ing in Deafness.U n ique C aseU n iversity ofToronto Med ical Exam inationsU norgan ized Fermen ts

U terus,Invers ion , R ecovery

U terus , C ono id C ervix, treatmen tU terin e Fib ro id s , Ergot inU terus , Fibroid , R emoval w ith Ovar iesU teiu s , New Materialfor Dilating O sU terus , S ubinvolution Of— ThomasU terus , Epi thelioma ofC ervixU terus , R e troflex ion of— ThomasU terine Hemorrhage , S econdary, by A. D. Millar , M.

D. , New Dund ee, O n t 232

U terine ~intra, Med ication , by J. C attermole, M.D etc. 323Vaccination Act, Bri tish 9 1Vaccination , Doubts ofthe Value of. 122Vagin i smus,treatmen t— Thomas 1 1 7Valvular Lesion s— Loom is 75Varicocele , New Mod e oftreating 3 1 1Vasel ine and S alicyl ic Acid i i i O bstetrics 74Vaso-Motor Mechan ism 86Vesico-Vag inal Fi stula, w ith. Prolapsus U teri, by J. M.

Sm i th , M .D . , Morpeth , O n t.Victoria C ollege, Med ical Department.Viru s , Action ofS unlight onVom iting ofPregnancy, Ingluv in inWarm -blooded An imals C onverted in to C oldWarren Trienn ial Priz eW ell-deserved Pun ishm en tWhite B lood C orpuscles , Migration ofWh ite C orpuscles in C oagulation ofBlood .

Women , Adm iss ion to Med ical DegreesWorm s

,Preven tion ofin C h ild ren

W riter’s C ramp